Navigation Links
Amerigroup Settles Federal and State Medicaid Fraud Claims for $225 Million

WASHINGTON, Aug. 14 /PRNewswire-USNewswire/ -- Amerigroup Corporation has agreed to pay $225 million to resolve claims that it defrauded the Illinois Medicaid program, the Justice Department and the Attorney General of Illinois announced today. Amerigroup, which is headquartered in Virginia Beach, Va., operates managed health care plans throughout the United States.

Today's settlement resolves allegations that Amerigroup and its Illinois subsidiary systematically avoided enrolling pregnant women, and unhealthy patients in their managed care program in Illinois. Amerigroup was paid by the United States and the state to operate a Medicaid managed care health plan in Illinois to provide health care to low income people. Amerigroup was required by law to enroll all eligible beneficiaries. The United States and the state of Illinois brought claims against the company alleging that it violated this requirement and avoided enrolling unhealthy patients, as well as pregnant women, who were more costly to treat and would have eroded Amerigroup's profit margin.

In October 2006, a jury found Amerigroup liable under the federal False Claims Act and the Illinois Whistleblower Reward and Protection Act. The court entered a $334 million judgment against Amerigroup, which then filed an appeal with the U.S. Court of Appeals for the Seventh Circuit in Chicago seeking a reversal of the judgment. As part of the settlement, Amerigroup will dismiss its appeal and has agreed to enter into a Corporate Integrity Agreement (CIA) with the Office of Inspector General for the U.S. Department of Health and Human Services (HHS).

"The Justice Department is committed to ensuring that recipients of federal health care funds adhere to the law, so that appropriate health care services are provided to all eligible patients," said Gregory G. Katsas, Assistant Attorney General for the Civil Division.

"A settlement of this magnitude sends the clear message that this office takes health care fraud very seriously," said Patrick J. Fitzgerald, U.S. Attorney for the Northern District of Illinois. "This case also illustrates the perils a defendant faces in taking a case such as this to trial."

"This settlement should send a clear message that the state of Illinois will not tolerate illegal conduct in the provision of healthcare for Illinoisans," said Illinois Attorney General Lisa Madigan. "I am pleased that our work on this case will bring millions of dollars to the State of Illinois."

The CIA between Amerigroup and its subsidiary health plans and the Office of Inspector General requires the company to adopt policies and procedures, and a code of conduct designed to prevent improper discrimination against federal health care program beneficiaries in its marketing and enrollment practices. The CIA applies to Amerigroup's managed care plans in all the states - currently 11 - in which the company does business during the term of the agreement. In addition, Amerigroup must hire an independent organization to annually review its marketing practices and enrollment initiatives, and its board of directors must certify the effectiveness of its compliance program each year.

"The Office of Inspector General is committed to protecting Medicaid beneficiaries from fraud and discrimination" said HHS Inspector General Daniel R. Levinson. "This Corporate Integrity Agreement will help ensure that our most vulnerable beneficiaries have access to needed Medicaid HMO plans in the future."

The lawsuit against Amerigroup was originally filed by Cleveland Tyson, a former company employee. Under the federal False Claims Act and the Illinois Whistleblower Reward and Protection Act, a private party, known as a relator, is entitled to file suit alleging fraud on behalf of the federal or state government, respectively, and receive a share of any recovery. As a result of today's recovery, Tyson will receive $56.25 million.

The case was handled by the U.S. Attorney's Office for the Northern District of Illinois and the Illinois State Attorney General's Office, with assistance from the Justice Department's Civil Division and the Office of Inspector General for HHS, as well as by private counsel for the relator.

SOURCE U.S. Department of Justice
Copyright©2008 PR Newswire.
All rights reserved

Related medicine news :

1. AMERIGROUP to Acquire Memphis Health Plan
2. AMERIGROUP Corporation to Host Investor Day
3. AMERIGROUP Names Mary McCluskey, MD, Chief Medical Officer
4. AMERIGROUP Contracts with Federal Government to Offer Medicare Advantage Health Plans in Seven States
5. AMERIGROUP Corporation to Discuss Third Quarter Earnings on October 25
6. AMERIGROUP to Participate in National Disability Mentoring Day
7. AMERIGROUP Corporation to Present at the 2007 Credit Suisse Healthcare Conference on November 13
8. AMERIGROUP Corporation to Present at the Merrill Lynch Health Services Investor Conference on November 27
9. AMERIGROUP Community Care Provides Doctors Office Makeover in Houston
10. AMERIGROUP Foundation Awards $100,000 to Grady Health System Foundation in Atlanta
11. AMERIGROUP Community Care of Georgia Wins New Health Plan Accreditation from NCQA
Post Your Comments:
(Date:12/1/2015)... Angeles, CA (PRWEB) , ... December 01, 2015 , ... ... United States, today announced that its iconic bottle has won top honors in Beverage ... category. The Company also announced that it has been selected as a 2015 ...
(Date:12/1/2015)... ... December 01, 2015 , ... Growth in medical payments per workers’ compensation ... utilization of hospital and nonhospital care, according to a recent study by the Workers ... 16th Edition , found medical payments per claim with more than seven days of ...
(Date:12/1/2015)... ... December 01, 2015 , ... CloudLIMS today ... Golden Bridge Business Awards under the New Products and Services category for its ... sample management software that helps labs organize data and track samples ...
(Date:12/1/2015)... ... December 01, 2015 , ... Diabetic ... United States. Podiatrists are well aware that psychology-based patient non-compliance (disobedience of a ... catastrophic contributors to diseases of the diabetic foot. The American Board of ...
(Date:12/1/2015)... IL (PRWEB) , ... December 01, 2015 , ... ... keeping their independence is everything. That is why Hollister Incorporated has launched the ... to offer this next product in the VaPro touch free catheter portfolio,” said ...
Breaking Medicine News(10 mins):
(Date:12/1/2015)... , Dec. 1, 2015 ... today announced that its Chief Executive Officer, ... the Oppenheimer Annual Healthcare Conference in New ... in the conference through a webcast on ... , --> ...
(Date:12/1/2015)... India and PITTSBURGH , ... today announced that it expects to be the first ... markets funded by international donors, TLE400 (Tenofovir Disoproxyl Fumarate ... mg) for $99 per patient, per year. Mylan partnered ... TLE400. The significantly reduced price could generate savings of ...
(Date:12/1/2015)... Breg, Inc ., a premier provider ... it has been awarded three contracts by Novation, a ... will have access to improved pricing for Breg,s portfolio ... goods dedicated to advancing orthopedic care.  ... population, rising prevalence of chronic conditions and the health ...
Breaking Medicine Technology: