Attorney General Sam Olens announced today that Innovative Resources Group, LLC, doing business as APS Healthcare Midwest, of
Under the GAMMP contract, APS Healthcare agreed to provide case and disease management services to Georgia Medicaid recipients while APS Healthcare was paid a monthly fee for each member receiving such services. The government contends that APS Healthcare failed to provide the required services to a large portion of the Medicaid recipients and over-billed DCH in its monthly invoices.
“This substantial recovery of taxpayer dollars is attributable to the continued strong partnership between state and federal law enforcement agencies in the fight against healthcare fraud and abuse,” said Georgia Senior Assistant Attorney General Scott Smeal.“This case should send a strong message to companies such as APS Healthcare that they will be held fully accountable if they fail to provide the services they promised to provide to Medicaid patients.”
“The Department is committed to protecting the integrity of the Georgia Medicaid program, its members and the taxpayer dollars used to provide this much needed service,” said Robert Finlayson, Georgia Department of Community Health’s Inspector General. “We will remain vigilant in our efforts to identify any detected fraud, abuse or waste and aggressively recover all funds spent inappropriately.”
“In this time of tight budgets and rising healthcare costs,
As part of the federal settlement, APS Healthcare has executed a Corporate Integrity Agreement (CIA) with the U.S. Department of Health and Human Services, Office of the Inspector General (HHS-OIG), which will require a robust compliance program. The CIA requires, among other things, intensive training and implementation of policies and procedures designed to ensure compliance with federal health care program requirements. In addition, APS Healthcare will be subject to external review of its compliance with state Medicaid contracts. If APS Healthcare fails to comply with certain material terms of the CIA, the company is subject to monetary penalties and exclusion from federal health care programs, including Medicare and Medicaid.
The civil settlement resolves a lawsuit filed under qui tam, or whistleblower, provisions of the False Claims Act, which allows private citizens to bring civil actions on behalf of the
Senior Assistant Attorney General Scott A. Smeal led the State’s investigation, assisted by auditors and investigators with the Georgia Medicaid Fraud Control Unit. The investigation was conducted jointly with members of the United States Attorney’s Office, the Federal Bureau of Investigation and HHS-OIG.