INDIANAPOLIS – A nursing home company will pay the State of Indiana and federal government $376,432 to settle allegations that it submitted ineligible bills to Medicaid for work performed by seven employees who have been excluded from the Medicaid program, Attorney General Greg Zoeller announced today.

The settlement that American Senior Communities LLC of Indianapolis agreed to pay is the largest settlement agreement the Indiana Attorney General’s Office has received in a Medicaid excluded-provider case to date. The case initially was investigated by the Attorney General’s Medicaid Fraud Control Unit (MFCU), which since early 2008 has settled with 36 health providers in such cases totaling $988,117.96 in state and federal recoveries.

“Ensuring that health care employees who serve our seniors and most vulnerable patients in the Medicaid program are qualified and worthy of people’s trust is a priority of my office. At a time when every tax dollar is precious, tracking down those ineligible to work in Medicaid in order to claw back overpayments is important and will hopefully ensure greater statutory compliance for providers in the future. When companies flout the rules and employ individuals undeserving of that trust, then the State of Indiana has an obligation to investigate so that Medicaid funds wrongly paid out can be recovered,” Zoeller said.

If individuals who work in health care professions are convicted of various crimes, then the federal government excludes them from involvement in Medicaid and other federally funded health care programs. That means health care providers are prohibited from billing federal health care programs for those employees’ services.

To enforce those exclusions, the Attorney General’s MFCU staff identifies individuals who worked for a Medicaid provider while excluded. They review records and determine if the health care provider billed Medicaid for services the workers performed – and if so, calculate the potential overpayment the provider received. When they find violations, MFCU can take legal action against the Medicaid provider or refer the case the U.S. Department of Health and Human Services’ Office of Inspector General (HHS-OIG) for legal action.

Based on this MFCU investigation, HHS-OIG alleged that American Senior Communities – a nursing and rehabilitation care company — employed seven individuals in Indiana whom the company knew or should have known were excluded from participation in Medicaid or other federal health care programs. To resolve the case, American Senior Communities has agreed to pay a civil monetary penalty of $376,432 for the combined federal-state recovery, of which the state’s portion is $130,040. The company denied any liability, and it agreed to implement policies and procedures to prevent hiring or contracting with any person or entity excluded from Medicaid, the agreement said.

A total of $988,117.96 in combined state and federal recoveries have been obtained through settlements with 36 excluded providers since early 2008 through the efforts of the Attorney General’s Medicaid Fraud Control Unit.

“We are pleased with our results in identifying excluded individuals working for nursing homes and other health care providers. Many hours have been spent identifying excluded individuals working illegally in the health care industry,” said Deputy Attorney General Allen K. Pope, director of the AG’s Medicaid Fraud Control Unit.

Pope noted that three deputy attorneys general, Nicholas Gonzales, Jessica Harlan and Steve Hunt, deserve special recognition for their work coordinating the collection of evidence, drafting pleadings, and negotiating settlements, as do current and former MFCU law clerks who worked on the project. “Their efforts have benefited the taxpayers of Indiana and of the United States directly in the amount of nearly $1 million dollars. Indirectly, they have saved the taxpayers far more by prodding many healthcare employers to establish a routine of regularly checking their employees against the federal government’s list of excluded individuals,” Pope said.