Insurance company did not follow applicable rules when setting rates, it charged for healthcare benefits under its Federal Employees health Benefits Program (FEHBP) contracts, and failed to give the healthcare program the same discounted rates it gave similarly situated commercial customers.
Insurance company did not follow applicable rules when setting rates, itcharged for healthcare benefits under its Federal Employees health BenefitsProgram (FEHBP) contracts, and failed to give the healthcare program the samediscounted rates it gave similarly situated commercial customers.It alsofailed to coordinate FEHBP benefits with those provided to Medicare eligibleannuitants and submitted statements to the Office of Personnel Management (OPM)that failed to fully disclose rate adjustments due to FEHBP.FraudWasteAbuseNeither2. The stateof California and the county of Los Angeles billed Medicaid for servicesprovided to minors when those jurisdictions had no basis for concluding thatthese individuals financially qualified for Medicaid services. The services atissue in this matter were treatment for drug and alcohol abuse, pregnancy andpregnancy-related services, family planning, sexual assault treatment, sexuallytransmitted diseases treatment, and mental health services.
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