tci Medicare Compliance & Reimbursement - 2003 Issue 19

Settlements: COMPUTER GLITCHES CAN COST YOU BIG

You don't have to profit from a billing snafu to have the feds come after you with a False Claims Act suit. Medicare contractor First Health Services Corp. learned that lesson April 23 when it agreed to a $13 million FCA settlement with the Department of Justice. According to U.S. Attorney Roscoe Howard, the company's failure to fix a computer glitch caused it to pay providers and health maintenance organizations in Washington, DC millions of dollars for services provided to ineligible Medicaid beneficiaries. The glitch caused beneficiaries' ineligibility dates to be overwritten with a default date of Dec...

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