Optimus HealthcareThe company, Fairfield County’s leading primary care provider, has agreed to pay state and federal governments nearly $500,000 to settle complaints that it has inflated profits with fraud. Medicaid and a Medicare bill.
The civil settlement, revealed Wednesday, is the result of a whistleblower complaint by the former defendant in 2019. optimus Employees accused the company of manipulating Medicare and Medicaid billing to mitigate the loss of double-insured patients who were denied treatment.
The whistleblower will collect approximately $63,000 from the settlement under federal false claims law provisions.
Optimus has 23 locations in southwestern Connecticut and is funded by federal and state governments.
The whistleblower led Optimus to bill Connecticut Medicaid for patients eligible for benefits under both the Medicaid and Medicare programs.
Some dual-eligible recipients are eligible for and receive full Medicaid coverage in addition to their Medicare coverage. Other dual eligible beneficiaries are known as: Eligible Medicare Recipient Eligible for Medicaid to pay your Medicare copays, premiums, coinsurance, and deductibles.
Optimus was accused of entering an erroneous Medicare denial code that amounted to a false charge to Connecticut Medicaid for a dual-eligible person. As a result, Medicaid ended up paying claims it would otherwise have refused.
In addition, Optimus was accused of unfairly billing Connecticut Medicaid for group therapy services for ineligible people.
Optimus has agreed to pay federal and state governments $470,093.93 for its conduct from January 2014 through December 2020.
