Keystone Peer Review Organization paying $1.6M in settlement with Gansler

By Bryan Cohen | May 29, 2014

BALTIMORE (Legal Newsline) - Maryland Attorney General Douglas Gansler announced a $1.675 million settlement agreement on Tuesday with a hospital and nursing home review company to resolve allegations it improperly performed a contract with the Medicaid program.

The Harrisburg, Pa.-based Keystone Peer Review Organization Inc. (KePRO) was hired to make sure the treatment given to Medicaid recipients in certain hospitals and nursing homes was medically necessary. While performing the contract, KePRO allegedly billed the Medicaid program for reviewing certain hospital stays for patients who did not receive Medicaid benefits.

"The use of taxpayer dollars should always be closely scrutinized," Gansler said. "This settlement ensures Marylanders are not paying more than they should for the work outlined in this contract."

KePRO also allegedly performed more reviews than were necessary to assess the care the patients received and evaluate the medical necessity of their treatment.

The KePRO settlement resulted from a joint inquiry by Gansler's Medicaid Fraud Control Unit and the Maryland Department of Health and Mental Hygiene. Gansler thanked Carol Kelly, an investigative auditor with the Medicaid Fraud Control Unit, and three assistant attorney generals, Shelly Marie, Michael Gorfinkle and David Lapp, for their work on the matter.

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