Michael Mosman, United States Attorney for the District of Oregon; Janet Rehnquist, Inspector General for the United States Department of Health and Human Services; and Oregon Attorney General Hardy Myers today announced the settlement of a case involving alleged fraudulent health care billings submitted to the Oregon Medicaid Program by the Gaston School District.
Staff from the Oregon United States Attorney's Office, the Oregon Department of Justice Medicaid Fraud Unit (MFU), and a Special Agent in the Portland Office of the Inspector General for the United States Department of Health and Human Services (HHS-OIG) collaborated on an investigation of Gaston's billings to the Oregon Medicaid Program for School-Based Health Services (SBHS). Through SBHS, the Medicaid Program reimburses eligible school districts for qualifying and documented medical services provided Medicaid-recipients, but does not pay for strictly educational services.
The investigation was instigated by a review of all Oregon school districts' Medicaid billings. This review followed a concerned citizen's report to a MFU investigator that certain school districts in Oregon had been improperly billing the Medicaid program for routine services not covered by Medicaid. As a result of this review, the HHS-OIG, United States Attorney's Office and the MFU undertook comprehensive audits of several Oregon school districts' billings, including the Gaston School District.
The audit focused on Gaston's Medicaid claims for basic health care services provided students; health screening/testing of students; provision of delegated health care services; and specialized transportation to/from qualifying health care services. As a result of the investigation and audit, attorneys for the U.S. Attorney's Office, HHS-OIG and MFU filed a complaint in federal court alleging that Gaston submitted false or fraudulent Medicaid claims for over $200,000 in SBHS that were not properly documented, were for services that not did not qualify for health care reimbursement, or which students did not actually receive.
This is the second case addressing Medicaid billings for SBHS pursued under federal law in Oregon. In an earlier settlement, Eagle Point School District agreed to pay $1.2 million to resolve claims that it improperly billed the Medicaid program for school-based health services. While denying liability for the allegations contained in the complaint, as part of a negotiated settlement, Gaston agreed to pay a total of $236,819.20 in damages and restitution related to its Medicaid claims submitted through December 2001. Oregon Attorney General Hardy Myers, commenting on the cooperative government effort, said, "We are committed to pursuing cases in which there have been improper payments obtained by the districts. Both public and private providers have a duty to bill Medicaid for only legitimately reimbursable services. Improper billings and payments only exacerbate the financial problems facing the Medicaid program in Oregon today."
Bob Nesler, AUSA, Oregon US Atty's Office, 503-727-1069
Andrew Whitman, Senior Counsel, US HHS-OIG, 202-401-4135
Ellyn Sternfield, Atty. in Charge, Oregon DOJ MFU, 503-229-5725 x241