Last Updated: 9:00 AM EST
The Florida Supreme Court ruled yesterday that the Agency for Health Care Administration cannot place a lien on a Medicaid beneficiary’s tort recovery that exceeds the cost of past medical expenses, overturning a lower court opinion in a dispute over a Medicaid lien for a recipient injured in a vehicular accident.The high court said that under the federal Medicaid Act, a state agency like AHCA can only recover past medical expenses, not future medical expenses, when a beneficiary wins money on tort claims in court. (Law360.com)
Brent E. Clark, M.D., a former family practice doctor in Pittsburgh, Pennsylvania agreed to pay $360,000 to the United States to settle claims that he violated the False Claims Act by submitting or causing to be submitted false claims to Medicare and Medicaid for medically unnecessary and unreasonable services, United States Attorney Scott W. Brady announced on Tuesday. Between February 2015 and February 2017, Clark billed Medicare and Medicaid for medically unreasonable and unnecessary office visits and procedures and falsified records to support the billings. The settlement follows Clark’s earlier guilty plea and sentencing on related criminal charges. (OIG.HHS.gov)
United States Attorney John H. Durham and Connecticut Attorney General George Jepsen announced on Tuesday that Arlene Werner, PhD., has entered into a civil settlement agreement with the federal and state governments and has paid more than $126,000 to resolve allegations that she violated the federal and state False Claims Acts. Werner is licensed as a Psychologist in the State of Connecticut and the owner of a private psychology practice in Waterford. She is enrolled as a provider in the Connecticut Medical Assistance Program (“CMAP”), which includes the state’s Medicaid program.
It is alleged that Werner billed Medicaid for psychotherapy services that were not provided and that she billed Medicaid for family psychotherapy sessions for multiple family members when she should have billed one family member for individual psychotherapy services. To resolve the allegations, Werner has paid $126,760.09 in order to reimburse the Medicaid program, which covers conduct occurring from January 2011 to July 18, 2016. (OIG.HHS.gov)
The owner of several Richmond, Virginia area medical support service companies has agreed to settle a civil fraud case alleging her companies defrauded the Virginia Medicaid program of over $1 million. The allegations involved Dawn Sykes owned and operated Open Arms Family Support Services, LLC; Open Arms Family Day Treatment Support Services, LLC; and Open Arms Mental Health Support Services, LLC from 2010 to 2017, which covers the time the Government alleged multiple fraudulent schemes, including: 1) Submission of claims to Medicaid for reimbursement of services not provided; 2) Sykes’ payment of kickbacks to an individual to induce client referrals; and 3) Submission of claims to Medicaid for reimbursement for services provided to ineligible recipients. Sykes reached a settlement agreement providing for an initial payment of $50,000 and a consent judgment of $1,061,613 to resolve an action commenced under the False Claims Act and the Virginia Fraud Against Taxpayers Act. Sykes also agreed to lifetime exclusion from the Virginia Medicaid Program. (Justice.gov)
Nebraska voters will decide whether to expand Medicaid in their state when they cast their ballots in November's midterm election. There have been 133,000 signatures collected by Insure the Good Life, an activist group seeking Medicaid expansion in Nebraska. Nebraska Governor Pete Ricketts commented "Nebraskans, however, should not buy into claims that expansion of government entitlement programs are justified as something that “save(s), create(s) and support(s)” jobs. Nebraskans have never used subjective measures touting “saved” or “supported” jobs when determining the efficacy of entitlement expansions, and it would be irresponsible to begin doing so today." (Governor.Nebraska.gov, TheHill.com)