Vermont Business Magazine The Attorney General’s Medicaid Fraud and Residential Abuse Unit (MFRAU) today announced a settlement with Health Care & Rehabilitation Services of Southeastern Vermont (HCRS) of Springfield resolving allegations that HCRS violated the Vermont False Claims Act. The settlement, reached in collaboration with the Office of the United States Attorney for the District of Vermont, resolves claims that HCRS improperly submitted Medicaid claims for services provided by an employee who was on the Office of the Inspector General, U.S. Department of Health and Human Services (OIG-HHS) exclusion list and barred from receiving payments from federally funded health care programs.
HCRS has agreed to pay to the State of Vermont and the United States a total of $170,037.76, of which Vermont Medicaid will receive $101,254.61 in program restitution.
“We thank HCRS for bringing this to the State’s attention and for their cooperation,” said Attorney General Donovan. “HCRS provides important care and services to some of the State’s most vulnerable Vermonters. Performing required background checks and complying with state and federal law is vital.”
As a health care entity submitting claims to Medicaid and other federally funded health care programs, HCRS is required to ensure that its employees are not on the exclusion list created and maintained by OIG-HHS. OIG-HHS may exclude individuals and entities from participation in these programs for a variety of reasons, including, but not limited to, fraud.
For a period of nearly 10 years, HCRS employed an individual identified on OIG-HHS’ exclusion list and submitted claims on the employee’s behalf for reimbursement to Medicaid, in violation of the Vermont False Claims Act. In addition, the United States Attorney’s Office for the District of Vermont has concluded that HCRS violated the federal False Claims Act.
The settlement announced today resolves these claims and HCRS has agreed to pay to the State and the United States a total of $170,037.76, of which Vermont Medicaid will receive $101,254.61 in program restitution. HCRS has already begun the payment process. The settlement amount reflects a cooperation credit in light of HCRS’s self-disclosure of the violation, assistance with the investigation, and voluntary adoption of remedial measures to guard against improper employment and claim submission in the future.
“It is imperative that organizations such as HCRS that provide important mental health, substance abuse, and developmental services to Vermonters, carefully vet their employees to ensure that all requirements are followed and taxpayer money is not paid out improperly,” said Acting U.S. Attorney Jonathan A. Ophardt. “I commend HCRS for bringing this issue to the government’s attention and committing to make changes to the ways in which it screens prospective and current employees so that it does not happen again.”
As a health care entity submitting claims to federally-funded health care programs, HCRS must ensure that its employees are not included on the exclusion list created and maintained by the Office of Inspector General of the Department of Health and Human Services (“OIG-HHS”). OIG-HHS may exclude individuals and entities from participation in these programs for a variety of reasons, including but not limited to fraud.
Assistant United States Attorney Lauren Almquist Lively handled this matter for the United States Attorney’s Office for the District of Vermont, in partnership with Assistant Attorney General Elizabeth L. Anderson, Director of MFRAU. Anne E. Cramer and Kevin M. Henry of Primmer Piper Eggleston & Cramer PC represented HCRS.
A copy of the settlement can be found here.
MFRAU receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $1,041,816 for Federal fiscal year FY 2021. The remaining 25 percent, totaling $347,272 for FY 2021, is funded by the State of Vermont.
Source: MONTPELIER – Vermont Attorney General 6.29.2021