Pediatric Services of America Agrees to Pay $6.88 Million to Settle Claims it Failed to Return Overpayments to Medicare and Medicaid
Two former employees of Pediatric Services of America and its affiliates will share a whistleblower reward of $1,121,729 for helping the government pursue claims that their former employer failed to return overpayments to Medicare and Medicaid.
This is the first settlement of a whistleblower lawsuit involving a health care provider’s failure to investigate credit balances on its books to determine whether they resulted from overpayments made by Medicare or Medicaid. Under the Affordable Care Act, healthcare providers must report and return any overpayments within 60 days after the overpayment is identified.
According to the whistleblowers’ complaint, Pediatric Services of America and related entities failed to disclose and return overpayments that it received from Medicare and Medicaid as required by the Affordable Care Act. The company and its affiliates were also accused of submitting claims for home nursing care without documenting the requisite monthly supervisory visits by a registered nurse, and submitting claims that overstated the length of time their staff had provided services.
If you have evidence that a healthcare provider has failed to return overpayments to Medicare or Medicaid, then you should consult with an experienced whistleblower lawyer immediately. You may be entitled to a substantial reward and legal protections as a whistleblower.
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