CHARLESTON — West Virginia Attorney General Patrick Morrisey's office has reached a settlement agreement with ResCare Inc. for $576,111.43 following an investigation initiated by the office's Medicaid Fraud Control Unit.
The office says ResCare submitted claims for payment to the West Virginia Medicaid program that were either unsupported by medical documentation, disallowed, in excess of the amount supported by medical documentation or the medical documentation maintained by ResCare failed to meet the state’s minimum documentation requirements.
The settlement includes restitution of $279,923.98 in Medicaid claims identified by the MFCU as being fraudulent, as well as additional recoveries totaling $296,187.45. Those additional funds will be used to pay for MFCU operating expenses.
Morrisey
“This is an important victory for West Virginians,” Morrisey said. “Health care providers need to know they must maintain accurate records and only bill for services they actually rendered. They must work within the parameters established by the West Virginia Medicaid Program.”
As part of the settlement, ResCare will begin an electronic records management system for its West Virginia locations it believes will minimize the company’s risk of submitting claims to the West Virginia Medicaid Program without medical documentation that complies with the state’s requirements.
The West Virginia Medicaid Fraud Control Unit—which joined 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 $2,204,588 for federal fiscal year 2022. The remaining 25 percent ($734,860) is funded by the state.