Health Care Fraud Prevention | CareSource Settlement

The Department of Justice recently intervened in and settled a False Claims Act case filed by two nurses against their employer, CareSource, an Ohio managed health care company. The settlement resolves allegations that the company caused Medicaid to make payments for assessments and case managements they failed to provide. According to the government’s February 1 press release, as part of the settlement, the whistleblower employees will receive a $3 million share of the federal portion of the $26 million settlement.

The release said, “This settlement will help ensure the provision of crucial services to Medicaid patients, especially children with special health care needs. The cooperation between federal and state agencies, along with assistance from the former employees who brought this issue to the government’s attention, demonstrates the determination necessary to protect the public’s precious health care resources.”

This settlement is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT). HEAT is a partnership between the Department of Justice and the Department of Health and Human Services. Together, these two federal agencies have focused efforts to reduce and prevent Medicare and Medicaid fraud through enhanced cooperation.

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