West Virginia Attorney General Patrick Morrisey said his office has reached a settlement agreement with ResCare Inc. for $576,111.43 following an investigation initiated by the Attorney General’s Office’s Medicaid Fraud Control Unit.
The investigation determined that ResCare submitted claims for payment to the West Virginia Medicaid program that were either unsupported by medical documentation, disallowed, in excess of the amount supported by medical documentation, or the medical documentation maintained by ResCare failed to meet the state’s minimum documentation requirements.
The settlement includes full restitution of $279,923.98 in Medicaid claims identified by the MFCU as being fraudulent, as well as additional recoveries totaling $296,187.45 which will be used to pay for the MFCU’s operating expenses.
“This is an important victory for West Virginians,” Attorney General Morrisey said. “Health care providers need to know they must maintain accurate records and only bill for services they actually rendered. They must work within the parameters established by the West Virginia Medicaid Program.”
As part of the settlement, ResCare is implementing an electronic records management system for its West Virginia locations that it believes will minimize the company’s risk of submitting claims to the West Virginia Medicaid Program without medical documentation that complies with the state’s requirements.
In announcing these actions, Attorney General Morrisey praised the work of the Medicaid Fraud Control Unit staff members who handled the case, including Investigator Casey Fledderman, Fraud Analyst Heather Watson and Deputy Director Michael Myers.
Anyone who suspects potential Medicaid fraud, or the neglect, abuse, or financial exploitation of incapacitated adults should report information to the Attorney General’s Medicaid Fraud Control Unit tip line at 888-372-8398 or via the Attorney General’s website at www.ago.wv.gov.
The West Virginia Medicaid Fraud Control Unit – which joined the Attorney General’s Office in 2019 – receives 75% of its funding from the U.S. Department of Health and Human Services under a grant award totaling $2,204,588 for federal fiscal year 2022. The remaining 25%, totaling $734,860, is funded by the State of West Virginia.
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