Justice Department Attorneys Announce $30.5 Million Settlement in Qui Tam Whistleblower Case of Medicaid Fraud

Another False Claims Act Recovery by Government Lawyers Is Part of $42.65 Million Heath Care Fraud Settlement

A qui tam whistleblower case alleging Medicaid fraud by Maximus, Inc. of Reston, Virginia led to a $30.5 million settlement under the False Claims Act this week.

According to the Justice Department, the whistleblower case settlement accompanied a deferred prosecution agreement and corporate integrity agreement by Maximus to end the government’s investigation of Maximus’ contract with the District of Columbia’s Child and Family Services Agency (CFSA). Maximus had contracted to assist CFSA in submiting claims to Medicaid for services that the District allegedly provided to children in its foster care program. The services were known as “target case management “(TCM) services, which were intended to help foster children with their medical, social and educational needs.

Maximus’s employees, including a former vice president, allegedly planned to cause CFSA to submit false claims to the Medicaid program for these TCM services for each child in its care, regardless whether the services had in fact been provided to those children.

The recovery totalled $42.65 million because the government had already recovered $12.15 million from CFSA. A review by the Department of Health and Human Services’ (HHS) Centers for Medicaid and Medicare Services had shown that CFSA could not support 35 percent of the “targeted” case management claims that it had submitted.

The American public should be grateful for persons of conscience who decide to become whistleblowers to stop such fraud. Many Americans who need health care could have been served by the Medicaid funds that were wrongfully obtained, and it is unconscionable to let heath care fraud continue to take money from deserving Americans.