Bridgeport-based Optimus Health Care Inc. has paid $470,093 to resolve allegations that it submitted false claims to the Connecticut Medicaid program and received overpayments from Medicaid for ineligible services.
The company, which has 23 locations in southwestern Connecticut, reached a civil settlement agreement with the state and federal governments, officials announced Wednesday.
The settlement amount covers the company’s conduct over a seven-year period, between January 2014 and December 2020.
A whistleblower, a former Optimus employee, brought the case to officials’ attention and will get a $62,787 share of the settlement, according to the U.S. Attorney’s office.
Optimus is a federally-qualified health center, so it receives patient revenues and grants from the federal and state governments.Â
Optimus submitted claims to Connecticut Medicaid for dual-eligible beneficiaries, who are Medicare beneficiaries who are also eligible for Medicaid coverage, according to the government.Â
Some dual-eligible beneficiaries are eligible for, and receive, full Medicaid coverage in addition to their Medicare coverage. However, other dual-eligible beneficiaries are qualified Medicare beneficiaries, who qualify for Medicaid to pay their Medicare co-pays, premiums, co-insurance and deductibles.Â
Optimus allegedly submitted false claims to Connecticut Medicaid for dual-eligible beneficiaries with the incorrect Medicare codes, causing Medicaid to pay claims it would have otherwise denied, according to the US. Attorney’s office.
Additionally, the government claimed Optimus improperly billed Connecticut Medicaid for group therapy services for qualified Medicare beneficiaries who were not eligible for reimbursement.
