Managed Care Company Settles False Claims Allegations for $4.6 Million

In this Labs in Court Weekly roundup, Molina allegedly submitted claims while not properly supervising and licensing mental health staff.

In key enforcement actions announced over the last week, Healthcare company Molina Healthcare and Pathways of Massachusetts, Molina’s previously owned subsidiary that provides mental health services, settled False Claims Act (FCA) allegations for $4.625 million.

According to the U.S. Department of Justice (DOJ), Molina, a managed care company offering health care plans to a variety of state and federal healthcare programs, and Pathways are alleged to have submitted claims to the joint federal and Massachusetts state Medicaid program MassHealth while not properly supervising and licensing mental health staff. They also allegedly failed to properly document that clinicians requiring supervision received it.

In addition to the above, the settlement also resolves allegations brought forth in a qui tam whistleblower lawsuit, the DOJ said in a statement.¹

In other key actions announced last week:

June 21: A Kentucky-based doctor settled FCA allegations for $561,800. Patrick C. Finney, MD, was accused of knowingly causing, and conspiring to cause, the submission of more than $3 million in false claims to Medicare by entering into an arrangement with locum tenens physician staffing firm Barton Associates, according to the DOJ. Finney allegedly provided telehealth services for Barton clients associated with referrals for genetic testing and durable medical equipment (DME). He is also alleged to have received illegal kickbacks from Barton and its clients in exchange for ordering or arranging to order DME and genetic testing, and for referring Medicare patients. Lastly, the DOJ alleges Finney falsely billed Medicare for DME and genetic testing that was not medically necessary and that had been “tainted by kickbacks.”²

Fraudulent billing of genetic testing has become a key enforcement target in recent years, as previously covered in National Lab Reporter.

June 21: A South Carolina nursing director pleaded guilty to lying to federal agents in relation to a fake COVID-19 vaccination card scheme. Tammy Hutson McDonald, former nursing director at a PruittHealth skilled nursing facility, was found to have provided several individuals with fake COVID-19 vaccination cards during several dates in 2021, according to the DOJ. However, when confronted by agents from the FBI and U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), McDonald said she had never provided fake or incorrect vaccine cards, though evidence proved the contrary. She now faces a maximum of five years in prison, restitution, a maximum fine of $250,000, as well as three years supervised release after any time she serves in prison.³

Managed Care Company Settles False Claims Allegations for $4.6 Million

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