WASHINGTON (Legal Newsline) — Florida Attorney General Pam Bondi announced June 20 that her office has joined 20 other states and the federal government in a settlement with CareCore National LLC after allegations the company submitted false claims to Medicaid.
CareCore provides utilization management services that help determine what medical services are necessary in various case. According to allegations, CareCore conducted a scheme of auto-approving radiology services that were not medically necessary. Because of this scheme, millions of dollars in false or fraudulent claims were submitted to and reimbursed by state Medicaid programs.
CareCore will pay the federal government $54 million to settle the allegations, $18 million of which will go to the state Medicaid programs. For its role, Florida will receive $1.4 million. This money will go toward restitution and other recoveries for the Medicaid program.
The initial allegations were asserted under a whistleblower lawsuit. The team handling the case involved representatives of the Florida, Georgia, New York and Ohio Medicaid Fraud Control Units. The states coordinated their case in conjunction with the U.S. Attorney’s Office for the Southern District of New York.