Bridgeport'sOptimusHealth Care pays $470K to settle Medicare fraud case, officials say [Journal Inquirer, Manchester, Conn.]

Aug. 9—The U.S. attorney's office said the settlement will resolve allegations that the company submitted false claims to the Connecticut Medicaid program and received overpayments from Medicaid for ineligible services.

In a separate news release, Connecticut Attorney General William Tong said Optimus Health Care "repeatedly overbilled Connecticut's Medicaid program, taking in payments they were ineligible to receive."

"I thank our federal partners at HHS-OIG and the U.S. Attorney's Office for their coordination and assistance in protecting our public healthcare programs and tax dollars," Tong said.

The U.S. attorney's office noted Optimus Health Care, Inc. has 23 locations in southwestern Connecticut. As an federally qualified health center, it said, Optimus receives patient revenues and grants from the federal and state governments.

"The allegations against Optimus arise out of claims submitted to Connecticut Medicaid for dual-eligible beneficiaries," the U.S. attorney's office said. "Dual-eligible beneficiaries are Medicare beneficiaries who are also eligible for Medicaid coverage. Some dual-eligible beneficiaries are eligible for, and receive, full Medicaid coverage in addition to their Medicare coverage."

Other dual-eligible beneficiaries are known as Qualified Medicare Beneficiaries, the U.S. attorney's office said, noting QMBs qualify for Medicaid to pay their Medicare co-pays, premiums, co-insurance and deductibles.

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The U.S. attorney's office said the government alleges that Optimus submitted false claims to Connecticut Medicaid for dual-eligible beneficiaries with the incorrect Medicare denial codes. It said that caused Medicaid to pay claims it would have otherwise denied.

"The government also alleges that Optimus improperly billed Connecticut Medicaid for group therapy services for QMBs who were not eligible for reimbursement for those services," it said.

To resolve its liability, the U.S. attorney's office said Optimus paid $470,000 to the federal and state governments for conduct that occurred between January 2014 and December 2020.

The U.S. attorney's office noted the allegations fall under the False Claims Act and were originally brought in a lawsuit filed in the U.S. District Court in Connecticut by whistleblower. It said lawsuits filed under the False Claims Act allow private parties to bring suit on behalf of the government and to share in any recovery.

As a result, the U.S. attorney's office said, the whistleblower, a former Optimus employee, will receive approximately $63,000 as her share of the recovery.

People who suspect health care fraud are encouraged to report it by calling 1-800-HHS-TIPS or the Health Care Task Force at (203) 777-6311.

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