A Pennsylvania Medicaid HMO settled civil fraud charges with the U.S. attorney in Philadelphia today, agreeing to pay $1.6 million for failing to reimburse hospitals and other providers with which it contracted.
U.S. Attorney Patrick Meehan alleged in the settlement that Philadelphia-based AmeriChoice of Pennsylvania, formerly known as Health Management Alternatives, violated the False Claims Act when it failed to process claims for reimbursement from 1995 to 1998 for providers' in its managed-care contract with the state. According to government documents, AmeriChoice of Pennsylvania failed to pay claims in a timely fashion, or at all; inaccurately reported claims data to the state; and failed to cover home health services for state Medicaid beneficiaries.
Parent company AmeriChoice Corp. serves 1.2 million government-plan beneficiaries in 13 states.
ACPA settled while denying wrongdoing, noting in the 15-page agreement that it sought to "avoid the delay, uncertainty, inconvenience and expense of protracted litigation. "
"Healthcare providers depend on timely payments by insurers," Meehan said in a news release. "The bottom line is that if the system isn't working properly and the provider isn't getting paid, it is ultimately the patient who suffers."
AmeriChoice of Pennsylvania signed a three-year corporate integrity agreement and agreed to monitoring by an independent review organization. It also agreed to maintain an automated query system allowing providers to determine the status of all claims and operate a verifiable, auditable claims system to make timely payment of provider claims.
Associate U.S. Attorney James Sheehan and Assistant U.S Attorney David Hoffman prosecuted the case, which was investigated by HHS' inspector general, the Federal Bureau of Investigation, the U.S. Postal Inspection Service and the Pennsylvania Medicaid Fraud Control Unit.