Maxim to pay $150M to N.J., other states in Medicaid claims settlement case

TRENTON – A large health care services company will have to pay New Jersey and several other states a total of $150 million as part of a settlement agreement, for submitting fake claims for government insurance benefits and running unlicensed offices around the country, state Attorney Gen. Paula Dow said today.

The investigation into Columbia, Md.-based Maxim Healthcare began five years ago, after a 55-year-old Ocean County patient who had been receiving home health care aid from a Maxim office challenged the claims and invoices the company had submitted to Medicaid.

The records kept by the patient showed that Maxim claimed more than 700 hours of services during a 15-month period between 2003 and 2004 that it didn’t actually provide, according to the Attorney General’s office.

Among the 13 unlicensed facilities in five states run by Columbia, Md.-based Maxim, two facilities were in New Jersey, one each in Mercer and Atlantic counties.

New Jersey is expected to recover some $2.7 million, the attorney general said.

“False billing to government health care programs has become a blight on our state,” Dow said in a statement. “Companies like Maxim, that provide health care services to Medicaid patients, are expected to take necessary steps to prevent fraud and abuse by instituting strong compliance programs and maintaining effective internal controls. Failure to do so will not be tolerated.”

The company is also required to pay a $20 million fine.

Before issuing the penalty that it did to Maxim, the state took into consideration Maxim’s cooperation and implementation of various reform measures in the years since the fraudulent acts were committed, the attorney general reported. They included the appointment of a new CEO in 2009, and various other administrative positions to ensure compliance.

In a statement, Maxim CEO Brad Bennett mentioned the higher sense of accountability the company has taken in recent years.

“While we regret the circumstances that led to this settlement, we have taken this opportunity to review our operations closely and strengthen our infrastructure, including our systems, policies and procedures,” he said. “This marks the beginning of a new chapter for our company. Maxim Healthcare remains strong and steadfast in its commitment to providing high quality care to the patients we serve.”

 

Maxim to pay $150M to N.J., other states in Medicaid claims settlement case