A New York health care company has agreed to pay $13 million to settle litigation that alleged the company submitted false claims to Medicaid through the Georgia Department of Community Health, the U.S. Attorney's Office and Georgia AG's office said.
Under the settlement announced Tuesday, APS Healthcare Midwest will pay $7.8 million to the state and $5.2 million for the federal share of Medicaid expenditures, the AG offices said. Under its state contract, APS Healthcare agreed to provide case and disease management to Georgia Medicaid recipients and was paid a monthly fee for each member who received the services. But the company failed to provide those serves to a large portion of the Medicaid recipients and over-billed the state in its invoices, the offices said.
Atlanta lawyer Julie Bracker, who represented a whistle-blower who initially brought the complaint, said the agreement will help protect Georgia's most vulnerable citizens while allowing taxpayers to recover millions of dollars.
"The case stands as a testament to what cooperation between the private sector, state government and federal government can accomplish," Bracker said. "In a time when the headlines talk about budget-based government shutdowns, and budget cuts to the United States Attorneys’ offices are threatened, it behooves us to recognize the enormous return on investment the government receives from prosecuting False Claims Act cases."
In a time of budget cuts, Georgia tried to improve its services to Medicaid recipients by contracting with APS Healthcare, U.S. Attorney Sally Yates said. "But instead of providing improved efficiency and effectiveness the company billed for, APS Healthcare took Medicaid's money for itself and left some of our most vulnerable citizens without the aid they deserved," she said.
As part of the settlement, APS Healthcare executed a corporate integrity agreement, which requires an aggressive compliance program, authorities said. In addition, APS Healthcare will be subject to external review of its compliance with state Medicaid contracts.
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