Corporate Compliance

NY's largest Medicaid provider settles fraud case for $35 million

Compliance Monitor, September 10, 2008

Healthfirst, the largest Medicaid managed care provider in New York, agreed to pay $35 million to settle allegations the company submitted false statements about its marketing practices.
 
According to a Department of Justice (DOJ) press release, Healthfirst compensated its representatives based on the number of people each representative enrolled in the program—a practice the law prohibits. In addition, Healthfirst lied to state and local government agencies about the policy and submitted false documents stating its representatives received bonuses based solely on qualitative criteria.
 
James Boothe, the former Executive Vice President and Chief Operating Officer of Healthfirst, faces criminal charges of insurance fraud, scheme to defraud, offering a false instrument for filing, and falsifying business records.
 
To read the DOJ press release click here

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