AG Coakley's Office Reaches Settlement with Maxim Healthcare Services Over Allegations of Medicaid Fraud
Maryland Company to Pay Massachusetts More Than $1.25 Million
"Taxpayers are defrauded when companies charge Medicaid for services they do not deliver," said AG Coakley. "We will continue to be vigilant in our scrutiny of every type of provider, including those who bill Medicaid for services rendered to consumers in their own homes."
The agreement reached Monday, settles allegations that Maxim offices in 41 states submitted claims for services not rendered and lacking the required documentation. The settlement also resolves allegations that certain Maxim facilities were not properly licensed and were therefore ineligible under the Medicaid rules to submit claims for reimbursement. Under the terms of the settlement, Maxim will pay $1,259,105 to the MassHealth program, which provides funds for health care products and services to eligible low-income individuals, including people with disabilities, children and elder citizens.
The Massachusetts recovery is part of a national settlement that will return more than $121 million to the Medicaid programs nationwide and an additional $9 million to other federally-funded health care programs. AG Coakley's office took an active role in securing this 41-state agreement as a member of the multi-state settlement negotiating team. AG Coakley's office worked in cooperation with the United States Attorneys' Office for the District of New Jersey, and with the United States Department of Justice, the Office of Inspector General of the U.S. Department of Health and Human Services, and representatives of the attorneys general of the states of New Jersey, Ohio, and Virginia.
The investigation that led to this settlement was prompted by a whistleblower lawsuit filed against the company in federal court in New Jersey. The whistleblower or "relator", who brought the suit on behalf of the government, is a New Jersey resident. The case began with allegations that a small number of false claims were filed on behalf of a single Medicaid recipient, and was subsequently developed by the government into a 41 state settlement.
Assistant Attorney General Robert Patten of AG Coakley's Medicaid Fraud Division served as a member of the state negotiating team in this national settlement. He was assisted by Data Analyst Anthony Megathlin, also of the Medicaid Fraud Division, and by Assistant Attorneys General and data analysts from New Jersey, Ohio and Virginia.