Two former employees of Ohio-based managed care plan provider, CareSource, filed a qui tam lawsuit under the False Claims Act, alleging that the company “knowingly failed to provide required screening, assessment and case management for adults, and children with special health care needs,” according to DoJ. Laura Rupert and Robin Herzog will receive over $3 million of the $26 million that CareSource has agreed to pay to resolve the lawsuit. According to the allegations:
“CareSource received millions of dollars in Medicaid funds to which it was not entitled. The CareSource entities subsequently submitted false data to the state of Ohio so that it appeared they were providing these required services to improperly retain incentives received from Ohio Medicaid and to avoid penalties.”
“Cash-strapped Medicaid programs, such as Ohio’s, can ill afford conduct such as this, designed to improve this company’s bottom line at the expense of a program benefitting the poor and disabled,” said Tony West, Assistant Attorney General for the Civil Division.