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Justice settles Medicaid fraud case
The Reston-based Maximus consulting company agreed yesterday to pay $30.5 million to resolve a criminal investigation into whether it falsified tens of millions of dollars in Medicaid claims prepared for the D.C. government.
The overall settlement, announced by the Justice Department, also includes more than $12 million that federal authorities said they recovered from the D.C. government in connection with the investigation.
Daniel R. Levinson, inspector general for the U.S. Department of Health and Human Services, said the agreement helps ensure Medicaid “is not exploited by consulting firms providing suspect reimbursement advice.”
Jeffrey A. Taylor, U.S. attorney for the District, said Maximus admitted its responsibility for causing “scarce Medicaid dollars to be spent for undocumented services that likely were never provided to some of the neediest residents of the District of Columbia.”
Mr. Turner’s complaint, filed in Alexandria federal court by attorney Candace McCall, stated the company overcharged Medicaid in connection with consulting services it provided to the D.C. Child and Family Services Agency.
However, Mr. Turner’s lawsuit charged the company’s work was “grounded in fraud.”
“After obtaining confirmation that such services were not performed through an [agency] computer search, and in the majority of instances after contacting the social workers who confirmed the services were not performed, Maximus nevertheless created files that indicated services were performed and used such information to demand Medicaid pay for services not rendered,” the lawsuit states.
Medicaid is a health-insurance program for low-income people paid for jointly by the federal and state governments. To bill Medicaid, providers are supposed to have extensive proof that services were provided.
But when Maximus began working for the city's foster care agency, many city documents were incomplete or missing, according to court records. So the company “created billing documents,” according to Mr. Turner’s complaint.
“Maximus would create an invoice for that beneficiary, as if services were performed, when there was no record of services having been performed,” the lawsuit stated. Among Maximus company employees, the process was dubbed “Operation Lightening Rod,” according to the suit.
Mr. Turner will receive $4.93 million as his share of the settlement.
Chief Executive Officer Richard Montoni said “Maximus accepts responsibility for the conduct of its employees, and since that time, we have taken remedial actions to improve oversight to prevent a recurrence.”
Maximus officials said the company would likely post a loss in the third quarter because of the settlement. The company also is exploring “strategic alternatives,” including a possible sale of the company.
Maximus spokeswoman Rachael Rowland said the unnamed employees no longer work for the company. She also said the settlement stemmed from “a single project dating back to 1999 that did not live up to our own professional standards.”
Maximus, founded in 1975 and publicly traded, employs thousands and posted revenues of more than $600 million in 2005.
Last year, Maximus announced the firing of Chief Executive Officer Lynn Davenport, citing unspecified conduct toward a former female employee. The company’s former chief financial officer, Mr. Montoni, was appointed to take over the job.
Under the settlement announced yesterday, the U.S. Attorney’s Office still reserves the right to file criminal charges if Maximus fails to comply with the terms. The deal also authorizes federal authorities the right to review Maximus‘ contracts and provide information to the company’s clients.
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