Insurance contractor pays $2M to settle Medicaid fraud

The primary contractor for Kentucky's Passport Health Plan will pay more than $2 million in damages to the state Medicaid program to settle a fraud investigation, reports the Louisville Courier-Journal.

The settlement follows a nine-month investigation by the office of Attorney General Jack Conway involving tips from a whistleblower inside AmeriHealth Mercy, the administrator for Passport Health Plan, according to the Richmond Register.

AmeriHealth allegedly falsely reported data to the Kentucky Medicaid Services Department on the number of Medicaid recipients who received cervical cancer screenings in 2009. The false numbers allowed AmeriHealth to receive almost $77,000 in bonus money under the terms of its contract.

The company agreed to implement measures to assure such fraud doesn't occur again, and Conway gave the company credit for "stepping up" and settling the issue when confronted with the evidence, the Register notes.

"We started this out as a potential criminal investigation, and we decided in looking at the evidence that it was pretty clear there was some evidence there were improper actions but it didn't really rise to the level of a criminal case we thought a grand jury would indict and we could win. Nevertheless, it made for a very, very strong civil fraud case," says Conway, according to WFPL.

According to AmeriHealth's statement, the employees responsible for the false reporting are no longer with the company. AmeriHealth also emphasized that the settlement "does not in any way constitute an admission of wrongdoing," reports the Courier-Journal.

To learn more:
- read the Louisville Courier-Journal article
- view the Richmond Register story
- check out the WFPL piece

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