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    Covering over well at Indian temple collapses, killing 35

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      Capito Introduces Three Bills to Combat Fentanyl

      Biden won’t veto Republican-led bill ending COVID emergency

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W.Va. AG, Hospital Reach $320K Medicaid Fraud Settlement

Gailyn Markham by Gailyn Markham
Thursday, March 4, 2021 1:43 pm

CHARLESTON, WV (LOOTPRESS) — West Virginia Attorney General Patrick Morrisey announced a more than $300,000 settlement with an in-state hospital accused of improperly billing Medicaid from 2014 to 2016.

The $320,175 settlement resolves allegations that Grant Memorial Hospital improperly billed Medicaid for services that a physician was not credentialed to provide. The hospital recognized the issue and disclosed it to authorities.

“Grant Memorial Hospital did the right thing by catching this fraud and reporting it,” Attorney General Morrisey said. “Fighting fraud takes a team approach. We encourage anyone who suspects Medicaid fraud to report it. Such theft takes resources from those who need it most, and that underscores why our office remains dedicated to fighting fraud, waste and abuse.”

Grant Memorial’s self-report, coupled with an investigation by the Attorney General’s Medicaid Fraud Control Unit and U.S. Health and Human Services, contend Dr. Amanda Borror was not credentialed to provide certain services when she began employment at the Petersburg, W.Va., hospital in September 2014.

Investigators allege Dr. Borror provided services under the National Provider Identifier of another physician, and Grant Memorial named that physician as the rendering provider. Dr. Borror also used that physician’s login credentials to access electronic health records for outpatient services, an attempt to make it appear that he had provided services and signed notes that were actually completed by Dr. Borror.

The alleged conduct resulted in Medicaid paying Grant Memorial’s submission of false claims for outpatient and inpatient services that were improperly billed under that physician’s credentials.

West Virginia will receive $302,108 from the settlement. The state will keep approximately $86,500, while the balance will reimburse federal Medicaid programs – a matter consistent with previous Medicaid settlements.

The West Virginia Bureau of Medicaid Services will receive approximately $57,724 of the state’s share.

The West Virginia Medicaid Fraud Control Unit — absorbed by the Attorney General’s Office in 2019 — receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $1,741,964 for the Federal Fiscal Year (FY) 2021. The remaining 25 percent, totaling $580,654 for FY 2021, is funded by West Virginia.

Attorney General Morrisey and the office’s Medicaid Fraud Control Unit participated in the investigation and settlement with the U.S. Attorney’s Office for the Northern District of West Virginia, the Office of Inspector General of the Department of Health and Human Services, West Virginia’s Bureau for Medical Services, the Defense Health Agency for TRICARE and the U.S. Department of Veterans Affairs.

Read a copy of the settlement at https://bit.ly/3usANl8.

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Gailyn Markham

Gailyn Markham

Gailyn Markham is a multimedia journalist for Lootpress. She joined the Lootpress staff in November of 2020. Gailyn graduated from Concord University in May of 2019 with a BA in English Journalism and a minor in Sociology. During her time there, she was a staff writer for the school’s newspaper, “The Concordian,” and received the 2019 Outstanding Journalist Award for her work. Before joining the Lootpress team, Gailyn interned for The Register-Herald and, upon completing her internship, was asked to continue working as a freelance writer. She freelanced for the newspaper for two years. A West Virginia native, Gailyn has always been devoted to telling the stories of the Mountain State. When she isn’t working, she enjoys taking advantage of West Virginia’s many outdoor adventures, reading, and renovating her home with her husband, Chris. For news tips or story ideas, email Gailyn at gailynmarkham@lootpress.com. You can also follow her on Facebook.

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