Ohio To Receive $446,878 In Medicaid Restitution

CLEVELAND, OH — Several states, including Ohio, agreed to join a settle between the federal government and CareCore National, a benefits management company. The settlement resolves allegations that the company improperly authorized medical procedures paid for with Medicare and Medicaid funds.

The company will pay the federal government $54, of which $18 million will go to state Medicaid programs. Ohio's Medicaid program will receive $446,878 in restitution.

The allegations against CareCore said the company created a scheme to automatically approve hundreds of radiology service requests every day. Those cases were approved as reasonable and medically necessary despite a lack of case-by-case evaluation.

The company employed this scheme to dodge untimely review penalties and keep up with the sheer volume of preauthorization requests for diagnostic radiology services. The allegations said the company engaged in these practices from Jan. 2005 through June 13, 2013.

More than 200,000 prior authorization requests were processed by the company during that time. The improper approval process led to a bevy of false claims being submitted to Medicaid programs.

The investigation into CareCore was conducted by the National Association of Medicaid Fraud Control Units team. The other states receiving restitution payments, besides Ohio, are Florida, Georgia, and New York.

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