On July 23, 2021, a notice of dismissal was filed indicating that SpectraCare Health Systems, Inc. agreed to pay $1 million dollars to resolve a federal qui tam lawsuit alleging that it violated the False Claims Act. The Government’s multi-year investigation, which spawned from a whistleblower complaint, investigated whether SpectraCare knowingly violated the False Claims Act by improperly billing Alabama Medicaid for Basic Living Skills services, and by failing to return overpayments to the Alabama Medicaid Agency, which constitutes a “reverse false claim” actionable under 3729(a)(1)(G) of the False Claims Act. SpectraCare Health Systems, Inc. is a 501(c)(3) nonprofit organization headquartered in Dothan, Alabama, which provides integrated healthcare services, including developmental disability services, intermediate care medical services, behavioral health services, and preventative programs to a range of patients. The company is contracted by the Alabama Department of Mental Health to provide services, which are paid for by the Alabama Medicaid Agency.
The settlement resolves allegations that, from October 1, 2012 through December 31, 2019, SpectraCare (1) knowingly submitted to Medicaid claims for reimbursement for services that were billed without complete and correct documentation, billed in duplicate, over-billed, or otherwise improperly billed, and/or (2) knowingly made, used, or caused to be made or used, false records or statements material to SpectraCare’s obligation to return overpayments to Medicaid based on such improper billing procedures, and/or (3) knowingly, intentionally, or recklessly failed to repay, or to exercise reasonable diligence to determine whether it was obligated to repay, Medicaid for SpectraCare’s improper claim submissions and their attendant overpayments.
