Vermont Business Magazine The State of Vermont and Mousetrap Pediatrics PC, have reached an agreement settling an investigation into whether Mousetrap submitted false claims or received overpayments from the Vermont Medicaid Program. Mousetrap operated as a pediatric physician group for over 25 years in the Franklin County area, until its dissolution in January 2016. The settlement resolves an investigation into Mousetrap’s Medicaid claims related to after-hours office visits. Mousetrap will pay $66,553.65 to settle potential claims under the Vermont False Claims Act. Under the settlement agreement, Mousetrap will repay the Medicaid Program the $51,553.65 it improperly received and a $15,000 civil penalty.
The investigation revealed that from January 28, 2013, through December 7, 2015, Mousetrap submitted claims to Medicaid using an improper billing codefor services provided during regularly scheduled extended office hours. Mousetrap received $51,553.65 more from the Vermont Medicaid program than it would have been entitled had the claims been properly submitted. The improper use of the billing code was caused by a change in Mousetrap’s business practices regarding extended offices hours, and not due to any intentional fraudulent behavior. MFRAU found that Mousetrap’s use of the code prior to January 28, 2013 did not violate any Medicaid or coding rules.
The settlement followed an investigation by the Medicaid Fraud and Residential Abuse Unit of the Office of the Attorney General and the Program Integrity Unit of the Department of Vermont Health Access.
A copy of the Settlement Agreement is available via the link below.
Source: Attorney General Nov 18, 2016