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Managed Care

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In each CMP case resolved through a settlement agreement, the settling party has contested the OIG's allegations and denied any liability. No CMP judgment or finding of liability has been made against the settling party.

2013

07-26-2013
Bravo Health Pennsylvania, Inc. (Bravo), Pennsylvania, agreed to pay $225,000 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Bravo provided medical records to the OIG's Office of Audit Services (OAS) in connection with an OAS audit that were intentionally altered prior to their submission or resubmission.

2007

11-07-2007
America's Health Choice, Inc. (AHC), Florida, agreed to pay $100,000 to resolve its liability under the OIG's CMP provision applicable to any Medicare Advantage organization that misrepresents or falsifies information to the Secretary of HHS (Secretary). The OIG alleged that AHC submitted documents to the Secretary that misrepresented the academic credentials of an AHC employee and submitted effectuation notices to the Center for Health Care Dispute Resolution (CHDR) in which dates of submission had been falsified to appear in compliance with CHDR's request for claims data.

2001

12-31-2001
Molina Medical Centers, a California Medicaid managed care plan, agreed to pay $600,000 to resolve its liability under the OIG's CMP provision applicable to any Medicaid managed care organization that misrepresents or falsifies information to an individual. The OIG alleged that the managed care plan sent misleading letters to its Medicaid enrollees in an effort to persuade the enrollees to continue to choose it as their Medicaid managed care plan. The OIG alleged that the letters appeared to be written and signed by the enrollees' primary care physicians even though they were actually written and signed by employees of the managed care plan.

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