Company to pay $2 million for doctoring Medicaid documents

The company that administers Medicaid for Jefferson and 15 other counties will pay more than $2 million in damages because it falsified documents to get a bonus.

AmeriHealth Mercy‘s altered data increased its score for the number of cervical cancer screenings its providers performed in 2009 and resulted in a bonus of $677,000. Attorney General Jack Conway said Wednesday that a whistleblower contacted his office nine months ago saying the company doctored reports that claimed the number of hysterectomies or Pap smears women had received.

AmeriHealth Mercy is the third-party administrator for Passport Health Plan, which manages Medicaid for about 165,000 members in Jefferson, Oldham, Trimble, Carroll, Henry, Shelby, Spencer, Bullitt, Nelson, Washington, Marion, Larue, Hardin, Grayson, Meade and Breckinridge counties. Passport manages the Medicaid program in those counties, while AmeriHealth processes the day-to-day claims as per a contact it holds with Passport. In a written statement, Passport said it may change its third-party administrator for some services.

In an agreement with Conway’s office, AmeriHealth will pay $2,032,758, which represents triple the amount it received in bonus money. The state is entitled to triple damages in these types of fraud cases. Because they both fund the program, the money will be split between the federal and state governments, The Lexington-Herald Leader reports.

Passport has been scrutinized by State Auditor Crit Luallen, who found the company squandered funds on meals, travel, lobbying and other expenses. Luallen further determined two top officials with the company were guilty of conflicts of interest. While overseeing the contract with AmeriHealth, the officials were also paid as consultants for the company, The Courier-Journal reports. Since the audit, Passport has fired two executives and hired an interim chief executive.

To read coverage from The Courier-Journal, click here; the Lexington Herald-Leader, here.

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