Two Western Blues plans and the joint venture that managed their Medicare contracts last week agreed to pay a total of $13.5 million in fines to resolve civil and criminal Medicare fraud charges.
In doing so, the plans became the latest Medicare contractors to settle charges that they defrauded the program they were hired to protect.
At a congressional hearing last month, the General Accounting Office and HHS' inspector general's office revealed that nine fiscal intermediaries have settled civil and criminal Medicare fraud charges and 21 are under investigation. The two plans that settled last week were among those 21.
The U.S. Justice Department and a 1996 civil whistleblower lawsuit, which the government joined as a plaintiff, accused the plans of falsifying their performance records to hang onto their Medicare contracts.
The plans are Blue Cross and Blue Shield of Colorado, Blue Cross and Blue Shield of New Mexico and Rocky Mountain Health Care Corp., the joint venture in charge of the companies' Medicare contracts. The plans served as Medicare fiscal intermediaries in Colorado and New Mexico from 1966 to 1994.
Under the settlement, the plans pleaded guilty to a single count of criminal conspiracy to obstruct a federal audit and resolved the civil charges without admitting wrongdoing.
They agreed to pay $12 million to settle the civil charges and $1.5 million to settle the criminal charge.