Amerihealth Mercy–the company that administers Medicaid in Jefferson and surrounding counties–will pay $2 million to the state.
AmeriHealth handles day-to-day operations for Passport Health Plan. Their payment to the state comes after a nine-month investigation by Attorney General Jack Conway’s office. Conway says AmeriHealth falsified cervical cancer screenings in order to receive a bonus from the state.
“We started this out as a potential criminal investigation, and we decided in looking at the evidence that it was pretty clear there was some evidence there were improper actions but it didn’t’ really rise to the level of a criminal case we thought a grand jury would indict and we could win. Nevertheless, it made for a very, very strong civil fraud case,” says Conway.
As is standard in Medicaid fraud cases, the payment to the state is triple the amount of the bonus Amerihealth received. AmeriHealth is still under contract with Passport.
“So I think some attention is going to be paid to this in the future,” says Conway. “But as far as criminal activity arising out of these particular circumstances, I think this pretty much dispenses with it.”
Passport was recently the subject of a scathing audit that found mismanagement and improper spending. Conway says his office is investigating allegations from the audit as well.
“There are other issues, other matters related to the Passport audit,” he says. “One specific issue related to the transfer of some payments between the entities that my office continues to examine to see if they were proper or not.”