East Central Family Health Center, Medicaid Fraud, Oklahoma 2012
Oklahoma City, Oklahoma - In a major healthcare scandal, East Central Family Health Center, a federally qualified health center located in Wetumka, Oklahoma, has agreed to pay $825,000 to settle civil claims stemming from allegations that it violated the False Claims Act by submitting false Medicaid claims.
The allegations, which date back to January 1, 2010, through April 30, 2012, contended that East Central submitted or caused to be submitted false claims for payment to the Oklahoma Medicaid program for behavioral health services furnished to Medicaid beneficiaries. Specifically, it was alleged that the false claims submitted to the Oklahoma Medicaid Program for reimbursement by East Central were for patients of non-FQHC health care providers and were not East Central patients.
Medicaid paid a higher amount for these services under the FQHC payment rate when these services should have been submitted as non-FQHC claims. East Central received a share of the rate for each encounter improperly billed to the Medicaid Program to which it was not entitled.
As part of the settlement, East Central has entered into a Corporate Integrity Agreement with the U.S. Department of Health and Human Services, Office of Inspector General, which requires additional record-keeping, reporting, and compliance requirements.
East Central, a designated federally qualified health center, receives grant funds from the U.S. Health and Human Services and provides primary health services to a specific medically underserved population. It also provides behavioral health and dental services.
The United States and Oklahoma contend that East Central submitted false claims for payment to the Oklahoma Medicaid program, which led to the center receiving a higher payment rate than it was entitled to.
The case was investigated by the Federal Bureau of Investigation, the U.S. Department of Health and Human Services Office of Inspector General, the Oklahoma Attorney General’s Office Medicaid Fraud Control Unit, and the Oklahoma Healthcare Authority. The case was prosecuted by Assistant United States Attorneys Ronald R. Gallegos and Scott Maule, and Oklahoma Assistant Attorney General Niki S. Batt.
Defendant: East Central Family Health Center
Criminal Charges: Violation of the False Claims Act by submitting false Medicaid claims
City and State: Oklahoma City, Oklahoma
Date: January 1, 2010 - April 30, 2012
Sentence or Outcome: East Central agreed to pay $825,000 to settle the allegations
Dollar Amount: $825,000
Key Facts
- State: Oklahoma
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
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