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Managed Care Provider CareSource Settles Health Care Fraud Whistleblower Lawsuit for $26 Million

According to a recent Department of Justice Press Release, Ohio-based CareSource, CareSource Management Group Co., and CareSource USA Holding Co. will pay the United States and Ohio $26 million to resolve allegations that they fraudulently billed Medicaid for assessments and case management that they did not actually provide to patients.  Two former employees, Laura Rupert and Robin Herzog, initiated the lawsuit by bring a qui tam action under the False Claims Act, alleging CareSource knowingly failed to provide required screening, assessment, and case management to adults and children with special needs.  CareSource allegedly received millions in Medicaid funds for work they did not perform.

Assistant Attorney General Tony West stated, “Cash-strapped Medicaid programs, such as Ohio’s, can ill afford conduct such as this, designed to improve this company’s bottom line at the expense of a program benefitting the poor and disabled.”  The federal False Claims Act and many similar state False Claims Acts reward whistleblowers who report fraud committed by companies against the government.  The federal False Claims Act also protects whistleblowers from reprisal by the company.  To learn more about the False Claims Act or to report fraud, click here.

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