AmeriHealth Mercy Health Plan, a third-party administrator for Passport Health Plan, Kentucky's Medicaid managed care plan, has agreed to pay $2 million in damages to the state for submitting false information in order to receive higher payments, according to a news release from Kentucky's Office of the Attorney General.
AMHP allegedly falsely reported its Health Effectiveness Data and Information Set score for the cervical cancer screening measure to the Department of Medicaid Services in 2009. HEDIS scores measure the performance of healthcare plans, such as how many Medicaid recipients received cervical cancer screens. For cervical cancer screening, the score is measure by determining how many eligible females received a pap smear. Members may be excluded if they received a full hysterectomy.
In 2009, AMHP contracted with University Health Care to manage the Passport Health Plan. Under the contract, AMHP could receive a bonus payment of more than $677,000 for higher cervical cancer screening scores. The state accused AMHP of excluding members as having a full hysterectomy when there was no medical evidence of a full hysterectomy, which increased the HEDIS score. AMHP also counted members as having received a Pap smear where there was no medical evidence of a Pap smear, which also increased the HEDIS score. The alleged activity caused AMHP to receive more than $677,000 from UHC in Medicaid funds.
According to a Courier-Journal news report, the AHMP employees responsible are no longer employed, and the organization has been cooperative during the investigation.
Read the news release about AHMP's settlement.
Read other coverage about settlements:
- 10 Big Anti-Kickback Cases Involving Hospitals in 2010
- St. Jude Medical to Pay $16M to Settle Kickback Allegations
- 7 Hospitals to Pay Over $6.3M to Resolve Kyphoplasty-Related False Claims Allegations
AMHP allegedly falsely reported its Health Effectiveness Data and Information Set score for the cervical cancer screening measure to the Department of Medicaid Services in 2009. HEDIS scores measure the performance of healthcare plans, such as how many Medicaid recipients received cervical cancer screens. For cervical cancer screening, the score is measure by determining how many eligible females received a pap smear. Members may be excluded if they received a full hysterectomy.
In 2009, AMHP contracted with University Health Care to manage the Passport Health Plan. Under the contract, AMHP could receive a bonus payment of more than $677,000 for higher cervical cancer screening scores. The state accused AMHP of excluding members as having a full hysterectomy when there was no medical evidence of a full hysterectomy, which increased the HEDIS score. AMHP also counted members as having received a Pap smear where there was no medical evidence of a Pap smear, which also increased the HEDIS score. The alleged activity caused AMHP to receive more than $677,000 from UHC in Medicaid funds.
According to a Courier-Journal news report, the AHMP employees responsible are no longer employed, and the organization has been cooperative during the investigation.
Read the news release about AHMP's settlement.
Read other coverage about settlements:
- 10 Big Anti-Kickback Cases Involving Hospitals in 2010
- St. Jude Medical to Pay $16M to Settle Kickback Allegations
- 7 Hospitals to Pay Over $6.3M to Resolve Kyphoplasty-Related False Claims Allegations