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Louisiana Health Dept. To Pay $13.42 Mln To Settle Alleged False Medical Claims

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The Louisiana Department of Health has agreed to pay $13.42 million as damages to settle allegations that it submitted false and inflated Medicaid claims for long-term nursing home and hospice care.

The Medicaid program grants federal share of the state's expenditures for healthcare services covered by the state's Medicaid plan in every quarter. The federal share is determined by a percentage rate that is subject to change from quarter to quarter.

Louisiana paid claims made by nursing homes and hospices, sought Federal reimbursement for those expenditures, and received Federal reimbursement based on the rate in effect at that time, the Department of Justice said in a press release.

The DOJ alleged that the Louisiana Department of Health knew that the rates determining the federal share of Louisiana's Medicaid payments were set to decrease following the months of December 2010, March 2011, June 2011, and September 2013.

To receive the higher Federal share percentage rates in effect during these months, the Louisiana Department of Health allowed its healthcare contractor, Molina Medical Solutions, to prepare, submit, and pay claims for nursing home and hospice services in these months, before the providers had submitted to Louisiana any claims for them.

Louisiana then claimed Federal reimbursement for those premature payments. As a result, the Louisiana Department of Health received a Federal share based on the higher percentage rate in effect in those months, rather than the lower percentage rate in effect the following months when the providers actually submitted their claims to Louisiana, the DOJ said.

The fraudulent claims were exposed in a joint investigation conducted by the Department of Justice, the U.S. Attorney's Office for the Middle District of Louisiana, and the U.S. Department of Health and Human Services Office of Inspector General.

Under the settlement agreement, the Louisiana Department of Health has agreed to pay $13,422,550 to the federal government.

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