HEALTH CARE
Maxim to Pay $150 Million Fine for Health Care Fraud


by Maggie Fox
Updated: September 12, 2011 | 3:14 p.m.
September 12, 2011 | 2:58 p.m.


Maxim, a company that provides help from licensed nurses to home health aides, has admitted to $61 million worth of federal fraud and agreed to pay civil and criminal penalties totaling $150 million, the Justice Department said on Monday.

Nine people who admitted defrauding Medicaid and the Department of Veterans Affairs are named in the settlement, including a Florida nurse who submitted false Medicaid bills and the mother of the child the nurse claimed to have cared for, as well as a home health aide in South Carolina who admitted to filling out faked time cards.

“Maxim has agreed to pay approximately $70 million to the federal government and approximately $60 million to 42 states – including more than $2.7 million to be paid to the state of New Jersey,” the Justice Department said in a statement. The company also will pay $20 million in criminal penalties.

“In addition, the company must also retain and pay an independent monitor, who will review Maxim’s business operations and regularly report concerning the company’s compliance with all federal and state health care laws, regulations, and programs,” according to the DOJ statement.

New Jersey Attorney General Paula Dow said the investigation began with a complaint from a Medicaid patient in New Jersey who filed a whistle-blower lawsuit.

“The investigation revealed that the submission of false bills to government health care programs was a common practice at Maxim from 2003 through 2009. During that time period, Maxim received more than $2 billion in reimbursements from government health care programs in 43 states based on billings submitted by Maxim,” DOJ said.

“Fraudulent billing for services not rendered uses patients as pawns in a game of corporate greed that puts cash over care and wastes precious taxpayer dollars,” added Tony West, Assistant Attorney General for the Civil Division at DOJ. “At a time when we're all looking for ways to reduce public expenditures, settlements like this one recapture taxpayer dollars lost to fraud and abuse, and help ensure that funds are available for the vital health care programs and services that people depend on day in and day out.”

The Medicare Fraud Strike Force, a joint effort of the Health and Human Services and Justice departments, has been working hard to make high-profile arrests. Preventing Medicare fraud is an area the Obama administration has tried to highlight as a benefit of the 2010 health-reform law. Last week the strike force indicted 91 people in connection with $295 million worth of fraud.