Ohio gets $10M in settlement

Keith Loria Feb. 1, 2011, 4:38am


COLUMBUS, Ohio (Legal Newsline) - Ohio Attorney General Mike DeWine announced on Tuesday that he and the federal government reached a $26 million settlement with a managed health care company that allegedly defrauded Medicaid.

The Dayton-based CareSource and its related corporate entities -CareSource Management Group and CareSource USA Holding - allegedly submitted false data that resulted in reimbursements from Medicaid for health care services it never provided.

"Medicaid program dollars need to be used to do what they are intended to do-and that is to provide health care to some of our most vulnerable citizens. Ohio taxpayers should expect no less," DeWine said.

"The defendants in this case defrauded the state's Medicaid program by failing to provide critical health care services, which is both unconscionable and unacceptable."

Between 2001 and 2006, DeWine's office alleged, CareSource allegedly failed to provide required screening, assessment and case management for children with special health care needs. The company also knowingly failed to do this for adults, DeWine said.

Due to its alleged misreporting, CareSource received millions of dollars in Medicaid funds that it was not entitled to. The company used this allegedly fraudulent data to make it seem as if it was providing these required services to retain incentives received from Ohio Medicaid improperly and to avoid penalties.

Under terms of the agreement, the company will pay $26 million to Ohio and the federal government, with the state receiving $10 million.

The case came about due to whistleblower action filed in the U.S. District Court for the Southern District of Ohio by two former CareSource employees. The whistleblowers will receive a share of nearly $3.1 million from the federal portion of the settlement.

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