TALLAHASSEE, Fla.—Attorney General Ashley Moody’s Medicaid Fraud Control Unit has secured nearly $600,000 for Florida Medicaid from a chronic disease management health care provider. In a multistate action involving Florida, Minnesota, and the federal government, Bluestone Physician Services of Florida, LLC, Bluestone Physician Services, P.A., and Bluestone National, LLC have agreed to pay millions of dollars for False Claims Act violations.
Bluestone allegedly violated the federal False Claims Act and the False Claims Acts of Florida and Minnesota by submitting false or fraudulent claims for certain evaluation and management codes. These services were provided to chronic care patients in assisted living and other care facilities but did not conform to Medicare, Medicaid, and TRICARE requirements. As a result of this settlement, Florida Medicaid will receive $593,038.
Attorney General Ashley Moody stated, “This chronic disease management health care provider sought payments from Medicare and Medicaid for higher, more expensive levels of medical services than those actually performed and payments for medically unnecessary services. This type of activity results in the overpayment of taxpayer funds through these programs. Thanks to the hard work of our Medicaid Fraud Control Unit, we have secured a nearly $600,000 payment to Florida Medicaid for these fraudulent claims.”
The multistate action resolves allegations that Bluestone submitted false claims for two evaluation and management codes: the domiciliary rest home visit code for established patients and the chronic care management code. The billed services did not conform with Medicare, Medicaid, and TRICARE requirements.
This action stems from a whistleblower lawsuit originally filed in the United States District Court for the Middle District of Florida.
The Florida Attorney General’s Medicaid Fraud Control Unit investigates and prosecutes providers that intentionally defraud the state’s Medicaid program through fraudulent billing practices. Additionally, it investigates allegations of patient abuse, neglect, and exploitation in facilities receiving payments under the Medicaid program.
The Florida MFCU is funded through a grant totaling $29,707,695 for Federal Fiscal Year 2024 from the U.S. Department of Health and Human Services-Office of Inspector General. The Federal Share of these funds is 75%, totaling $22,280,772. The State Matching Share is 25%, totaling $7,426,923 funded by Florida.