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Showing 2 posts in Medicaid.

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The Virginia Birth-Related Neurological Injury Compensation Program Settles for $20.7 Million

March 18, 2019

The Virginia Birth-Related Neurological Injury Compensation Program ("The Program") and the Virginia Birth-Related Neurological Injury Compensation Fund ("The Fund") have recently agreed to pay a $20.7 million settlement to resolve FCA allegation brought against them by a whistleblower suit.  Relators allege that the defendants knowingly caused numerous Program participants to submit false claims to Medicaid.  By law, Medicaid is the "payer of last resort" for all healthcare claims for a covered beneficiary, meaning if another insurer or program has the responsibility to pay for medical costs incurred by a Medicaid-eligible individual, that entity is generally required to pay all of or part of the costs of the claim before Medicaid makes any payment.  If a third party is liable to pay for part of a Medicaid participant's care, "Medicaid will only pay that part of the care which is over and above the amount covered by the third party."[1]   The text of Va. Code Ann. §38.2-5009 specifically says that the Program will not cover any items or expenses that would be covered "under the laws of any state or the federal government except to the extent prohibited by federal law."  However, the Program and the Fund made themselves the de facto payers of last resort, improperly shifting payment onto the Medicaid program.  More

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Four Houston-Area Hospitals Pay $8.6 Million to Settle Ambulance Swapping Allegations

December 5, 2017

Four Houston-area hospitals have paid $8.6 million collectively to settle allegations of "ambulance swapping"—that ambulance companies paid kickbacks to the hospitals in exchange for the hospitals' lucrative Medicare and Medicaid transport referrals. The hospitals—Bayshore Medical Center, Clear Lake Regional Medical Center, West Houston Medical Center, and East Houston Regional Medical Center—are all affiliates of the Nashville-based Hospital Corporation of America. More

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