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Morris said CareSource fully complied with the U. Department of Health and Human Services for five years. It admitted no wrongdoing in the settlement agreement.
Rupert and Herzog worked as telephonic case management queue nurses at CareSource from March until July CareSource therefore realizes lower profits when utilization is higher, according to the complaint.
The complaint alleges CareSource fudged data used to determine whether it is entitled to retain a 1 percent reserve fund, forfeit the reserve fund, or receive a bonus. The state stopped requiring managed-care companies to report such data in , he said.
While the lawsuit against CareSource is a concern to the agency, it is satisfied with the settlement, he said. The reason: it did not need to employ as many workers, thus saving money. They are accused of causing Medicaid to make payments for assessments and case managements they failed to provide to children and adults.
Originally filed in November , the United States alleged that between January and December , the CareSource entities knowingly failed to provide required screening, assessment and case management for adults, and children with special health care needs. As a result, it was alleged that CareSource received millions of dollars in Medicaid funds to which it was not entitled. The CareSource entities subsequently submitted false data to the state of Ohio so that it appeared they were providing these required services to improperly retain incentives received from Ohio Medicaid and to avoid penalties.
If you have a similar case please fill out the form below or email mail whistleblowerinstitute. If you or someone you know experienced a similar situation or any other wrongdoing within a corporation you should contact mail whistleblowerinstitute.
The Whistleblower Institute is an information portal for current or former employees and other people having insight information about wrongdoing and other illegal activities by individuals either individually or within corporations, through company culture and or within international affairs.
This website is dedicated to the fight against corporations violation national laws and international laws driven by corporate greed. We help whistleblowers find answers to their questions and solutions to their problems. Know More. Date Filed:. Monday, November 13,
WebProgenyHealth, Inc. v. CareSource Management Group Co., No. cv - Document 13 (S.D. Ohio ) Court Description: ENTRY AND ORDER granting 10 . WebFalse Claims Act | CareSource CareSource Provider Overview Education Fraud, Waste & Abuse False Claims Act False Claims Act On February 8, , President George W. . WebCareSource not only dwarfs its competitors in size, it also logs more complaints, with the vast majority coming from health care providers. Of provider complaints last year, .