Edgewater Systems to pay $1.25M in Medicaid claims settlement

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[MM Curator Summary]: The counseling firm failed to get sign off from qualified providers on individualized care plans.



Clipped from: https://www.insideindianabusiness.com/articles/edgewater-systems-to-pay-1-25m-in-medicaid-claims-settlement

Tuesday, October 3, 2023 12:30 PM EDT

By Carley Lanich


(Adobe Stock Photo)

HAMMOND, Ind. – A Gary-based health care provider is expected to pay the state $1.25 million to resolve claims the company fraudulently billed the Indiana Medicaid program for mental health services.

U.S. Attorney Clifford Johnson’s office announced in a press release that state and federal officials reached a settlement with Edgewater Systems for Balanced Living to resolve civil claims brought against the company.

The Indiana Medicaid program — which provides services to low-income, often uninsured Hoosiers — is funded jointly by the state and federal government.

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Federal officials say Edgewater repeatedly billed Indiana Medicaid for mental health counseling sessions that failed to meet a requirement stating providers must draft an individualized care plan signed by a qualifying physician or health service provider before billing Medicaid.

Officials say the billing occurred between November 1, 2012 and December 31, 2017. They also said they believed Edgewater should have been aware of the billing requirement due to past negative audits.

Assistant U.S. Attorney Wayne T. Ault handled the settlement negociation following an investigation initiated by the northern district court and conducted with assistance from the Indiana Attorney General’s Medicaid Fraud Control Unit.