A whistleblower case claiming Molina Healthcare overbilled the Illinois Medicaid program will move forward after the U.S. Supreme Court declined to hear a challenge Monday.
It was one of three cases the court declined to hear challenging whether whistleblowers must provide details of false claims act allegations, according to court documents.
In 2017, founder of former Molina contractor GenMed, Thomas Prose, filed a lawsuit in the Northern District of Illinois, alleging the payer sought and obtained compensation despite failing to provide the material services required under its contract.
The payer had previously contracted with GenMed to provide skilled nursing facility services for sick, disabled or elderly patients who need long-term medical and nursing care without hospitalization.
Under the arrangement, patients were divided into tiers based on the level of care needed, with Molina receiving $54 for patients at the lowest tier, and $3,127 for the highest tier of patients living in nursing facilities. Molina received full capitation payments from the government, then paid GenMed an agreed amount, according to the lawsuit.
The contracting arrangement lasted about nine months until Molina tried to renegotiate terms of the contract and GenMed terminated it, according to the suit. The payer received capitation amounts for SNF services after terminating the contract, even though it did not contract with another group to provide SNF services, the suit alleges.
Molina moved...
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