BCBS IL to Pay $25M to Settle Medicaid False Claims Allegations

John Commins, for HealthLeaders Media , February 25, 2011

BCBS IL issued the following statement: "Our agreement with the state attorney general and the federal government resolves a long-standing dispute concerning certain claims involving private duty nursing benefits. While we disagree with the allegations and deny any inappropriate conduct at any time, we are pleased to put this matter behind us and focus on serving the needs of our policyholders. This dispute began many years ago when we reviewed certain claims and determined that the benefits sought were not covered by the applicable insurance plans and policies. These plans and polices determine which benefits are covered and which are not. Several years ago, in cooperation with the state attorney general, we expanded our explanation of benefits to ensure that our members understood what nursing benefits are covered under their plans. That action, coupled with today's agreement, are in the best interests of our members."

DOJ has used the False Claims Act to recover more than $5.5 billion since January 2009 in cases involving fraud against federal healthcare programs. The Justice Department's total recoveries in False Claims Act cases since January 2009 are nearly $7 billion.

John Commins is a senior editor with HealthLeaders Media.

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