North Carolina Attorney General Cooper Settles Two Medicaid Fraud Cases

North Carolina Attorney General Cooper Settles Two Medicaid Fraud Cases
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September 28, 2015

Two health care companies are prepared to pay to settle allegations of unlawful business practices and Medicaid Fraud, with North Carolina specifically receiving $1.8 million, according to Attorney General Roy Cooper.

"Cheating Medicaid wastes tax dollars and harms patients in need of medical care," Cooper said in a written statement. "Our investigators and attorneys will continue their work to root out fraud and abuse in the health care system."

Adventist will pay North Carolina, Florida and the federal government $118 million to resolve allegations that it submitted false claims to Medicaid and Medicare. Cooper claims that, between January 1, 2007 and December 31, 2012, the company paid illegal bonuses to doctors based on the number of tests and procedures they ordered. The incentivizing of tests resulted in unnecessary claims billed to Medicaid.

North Carolina will receive nearly $200,000 in the settlement. The proceeds will be used to support Medicaid and the public school system.

Physicians Pharmacy Alliance (PPA) has also agreed to a settlement, resolving charges that it violated laws prohibiting kickbacks. From January 1, 2008 to January 4, 2011, the company waived patient copays and gave gift cards to patients and employees at doctors' offices and community health centers to entice them to enroll with or refer patients to PPA.

The settlement includes $867,539 for Medicaid efforts in the state and $805,724.93 in civil penalties that benefit North Carolina public schools.

Both Adventist and PPA cooperated fully with the investigation performed by Cooper's Medicaid Investigations Division (MID).