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National Health Care Company Settles Fraud Allegations
September 14, 2011
AUGUSTA – Attorney General William J. Schneider announced today that Maine reached an agreement with Maxim Healthcare Services, Inc. (Maxim) to resolve allegations that it defrauded the Medicaid and Veterans Affairs health care benefits programs. The settlement will return $71,994 state only funds to the MaineCare program.
Maxim, one of the nation’s largest health care staffing agencies, has over 300 offices in more than 40 states, including Maine. The company provides in-home nursing and health aide services to patients with disabilities.
The settlement is the culmination of a more than five-year investigation by state and federal authorities into allegations that Maxim: (1) submitted false claims to government health care benefits programs for services to patients that were not provided; (2) submitted government health care benefits program claims that were improperly documented, and therefore not reimbursable; and (3) operated health care staffing offices that were not licensed under applicable state laws and regulations.
“Companies like Maxim must prevent fraud and abuse by implementing effective compliance programs and internal controls,” Attorney General Schneider said. “Overbilling schemes use patients as pawns, causing real harm and ultimately costing all of us.”
The Maxim investigation was initiated following a complaint by a Medicaid patient who lived in Ocean County, New Jersey. In 2003-04, the then 55 year-old patient received home nursing services staffed by Maxim. When Medicaid informed him that the company had submitted invoices for services beyond his monthly Medicaid benefits allotment, the patient challenged the veracity of Maxim’s invoices. According to the patient’s records, during a 15-month period between 2003 and 2004, Maxim claimed more than 700 hours of services that were not provided. He initiated a qui tam lawsuit as a relator on behalf of the federal and state governments.
The multi-state investigation was spearheaded by the New Jersey Attorney General’s Office, the U.S. Attorney’s Office for the District of New Jersey, the FBI, and the departments of Justice, Health & Human Services and Veterans Affairs.
As the investigation expanded, the New Jersey Attorney General’s Office led the team of states, along with Virginia and Massachusetts, which eventually included attorneys general from 41 states. The resolution with Maxim includes a deferred criminal prosecution agreement with the U.S. Attorney’s Office; a federal civil settlement agreement with the U.S. Attorney’s Office and Civil Division of the Department of Justice on behalf of the Departments of Health & Human Services and Veterans Affairs; and a corporate integrity agreement with the Department of Health & Human Services.
The total amount of the state and federal civil settlements is $130 million, of which approximately $121.5 million is allocated to the Medicaid program, and approximately $8.5 million to the Veterans’ Affairs program.
Maine was represented by Assistant Attorney General Michael Miller, Director of the Healthcare Crimes Unit.
The Healthcare Crimes Unit is the Medicaid Fraud Control Unit for the State of Maine charged with investigating and prosecuting financial fraud and other crimes committed by MaineCare providers or their employees, and investigating and prosecuting abuse, neglect or exploitation of elderly and dependent persons that occurs in health care facilities or by health care providers.
To learn more about the Office of the Attorney General Healthcare Crimes Unit, go to:
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