Oklahoma Federally Qualified Health Center Agrees to Pay $825,000 to Settle Allegations of Submitting False Medicaid Claims for Medical Services
OKLAHOMA CITY, OK—Sanford C. Coats, United States Attorney for the Western District of Oklahoma and E. Scott Pruitt, Attorney General for the State of Oklahoma (“Oklahoma”), jointly announce that EAST CENTRAL FAMILY HEALTH CENTER has agreed to pay $825,000 to settle civil claims stemming from allegations that it violated the False Claims Act by submitting false Medicaid claims.
East Central is a designated federally qualified health center (FQHC) located in Wetumka, Oklahoma. It receives grant funds from the U.S. Health and Human Services and provides primary health services to a specific medically underserved population. East Central also provides behavioral health and dental services. As an FQHC, East Central was certified to participate in the Oklahoma Medicaid Program. For each office encounter, it was paid a flat amount under a prospective payment system rather than a fee for service as determined by the condition being treated. The FQHC rate per encounter is generally higher than the rate received by non-FQHC providers.
The United States and Oklahoma contend that East Central submitted or caused to be submitted false claims for payment to the Oklahoma Medicaid program for behavioral health services furnished to Medicaid beneficiaries during the period from January 1, 2010, through April 30, 2012. Specifically, it is alleged the false claims submitted to the Oklahoma Medicaid Program for reimbursement by East Central were for patients of non-FQHC health care providers and were not East Central patients. Medicaid paid a higher amount for these services under the FQHC payment rate when these services should have been submitted as non-FQHC claims. East Central received a share of the rate for each encounter improperly billed to the Medicaid Program to which it was not entitled.
In order to resolve the allegations brought by the United States and Oklahoma, East Central agreed to pay $825,000. As part of the settlement, East Central has also entered into a Corporate Integrity Agreement with the U.S. Department of Health and Human Services, Office of Inspector General, which requires, among other things, additional record-keeping, reporting and compliance requirements. In reaching this settlement, East Central did not admit liability and the government did not make any concessions regarding the legitimacy of the claims. The agreement allows the parties to avoid the delay, expense, inconvenience, and uncertainty involved in litigating the case.
This case was investigated by the Federal Bureau of Investigation, the U.S. Department of Health and Human Services Office of Inspector General, the Oklahoma Attorney General’s Office Medicaid Fraud Control Unit, and the Oklahoma Healthcare Authority. The case was prosecuted by Assistant United States Attorneys Ronald R. Gallegos and Scott Maule, and Oklahoma Assistant Attorney General Niki S. Batt.