CHARLESTON — West Virginia Attorney General Patrick Morrisey's has reached a settlement of more than $300,000 with an in-state hospital accused of improperly billing Medicaid from 2014 to 2016.
The $320,175 settlement resolves allegations that Grant Memorial Hospital improperly billed Medicaid for services that a physician was not credentialed to provide. The hospital recognized the issue and disclosed it to authorities.
“Grant Memorial Hospital did the right thing by catching this fraud and reporting it,” Morrisey said. “Fighting fraud takes a team approach. We encourage anyone who suspects Medicaid fraud to report it. Such theft takes resources from those who need it most, and that underscores why our office remains dedicated to fighting fraud, waste and abuse.”
Grant Memorial’s self-report, coupled with an investigation by the Attorney General’s Medicaid Fraud Control Unit and U.S. Health and Human Services, contend Dr. Amanda Borror was not credentialed to provide certain services when she began employment at the Petersburg hospital in September 2014.
Investigators allege Borror provided services under the National Provider Identifier of another physician, and Grant Memorial named that physician as the rendering provider. Borror also used that physician’s login credentials to access electronic health records for outpatient services, an attempt to make it appear that he had provided services and signed notes that were actually completed by Borror.
The alleged conduct resulted in Medicaid paying Grant Memorial’s submission of false claims for outpatient and inpatient services that were improperly billed under that physician’s credentials.
West Virginia will receive $302,108 from the settlement. The state will keep approximately $86,500, while the balance will reimburse federal Medicaid programs – a matter consistent with previous Medicaid settlements.
The West Virginia Bureau of Medicaid Services will receive approximately $57,724 of the state’s share.
The West Virginia Medicaid Fraud Control Unit — absorbed by the Attorney General’s Office in 2019 — receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $1,741,964 for the Federal Fiscal Year (FY) 2021. The remaining 25 percent, totaling $580,654 for FY 2021, is funded by West Virginia.
Morrisey and the office’s Medicaid Fraud Control Unit participated in the investigation and settlement with the U.S. Attorney’s Office for the Northern District of West Virginia, the Office of Inspector General of the Department of Health and Human Services, West Virginia’s Bureau for Medical Services, the Defense Health Agency for TRICARE and the U.S. Department of Veterans Affairs.