A whistleblower lawsuit alleging a healthcare company submitted Medicaid false claims has been closed out due to a settlement. The Medicaid false claims case alleged that a healthcare company, Centers Plan For Healthy Living, billed Medicaid for long-term care services that members either never received or didn’t qualify for.

The Medicaid false claims allegations were resolved when a $1.65 million joint state and federal settlement agreement with the healthcare company was made. New York Attorney General Barbara D. Underwood announced the resolution to the Medicaid false claims case.

The Medicaid false claims allegations were reportedly based on complaints that the Centers Plan For Healthy Living LLC managed their long-term care plan by making false requests to New York’s Medicaid program for premiums paid out monthly.

The Medicaid false claims lawsuit accused the company of violating the state laws and the Federal False Claims Act. Medicaid is a dual funded federal and state healthcare program that gives access to healthcare for those who cannot otherwise afford it. Managed long term care plans receive what is known as a monthly capitation payment from Medicaid.

These are similar to insurance premiums for every member that is set up in the managed long-term care plan. The exchange for this has to do with a company setting up and administering certain long term care services within the community, such as therapies in the home, personal care services in the patient’s home, skilled nursing services in the house of the patient, and adult health daycare.

A Medicaid beneficiary has to meet certain qualifications in order to qualify for a managed long term care plan, including being assessed as in need of those services. A joint investigation determined, however, that the center’s program was involved in sending Medicaid false claims.

For several different members, there existed no records explaining that the Centers Plan For Healthy Living gave those members any eligible services whatsoever for the duration of their enrollment period. Furthermore, the Medicaid false claims case alleged that the company was responsible for failing to dis-enroll members in a timely fashion and kept collecting monthly premiums even though those members were no longer eligible to receive them.

The settlement agreement in the Medicaid false claims case resolves federal as well as state allegations that Centers Plan For Healthy Living was submitting false claims for the payments on a monthly basis for members in the managed long term care program who didn’t receive the qualifying long-term care services and should not have been in the program.

A Medicaid false claims lawsuit can be brought by the government authorities as a result of an investigation, but whistleblowers with inside information about fraud might also be the ones to start an investigation. Federal and state laws are in place to encourage and protect whistleblowers who report information about fraud against the government.

If you or someone you know becomes aware of issues related to Medicaid false claims, you may be eligible to recover compensation and receive protections as a whistleblower.