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Health Care Firm to Pay $150 Million for Defrauding U.S., State Agencies

Maxim Healthcare Services has agreed to pay $150 million to settle criminal and civil charges that it fraudulently overbilled federal and state health-care benefits programs.

The Columbia, Md.,-based company also entered into a criminal deferred prosecution agreement with the U.S. Attorney’s office in Newark, which conditionally allows it to avoid a potential health care fraud conviction. Federal authorities said the company, one of the nation’s largest providers of home health care services, admitted to conspiring to defraud Medicaid and the Department of Veterans Affairs programs out of more than $61 million between 2003 and 2009.

The settlement includes a $20 million criminal fine and the payment of $130 million to resolve civil allegations made by the federal government and 43 states. As Bloomberg reports, authorities called it the biggest civil recovery ever in a home health care fraud.

Since 2009, nine people, including eight former Maxim employees, have pleaded guilty to felony charges related to the case. Authorities said the fraud included, among other things, billing government programs for services that weren’t provided as well as submitting falsified claims to conceal work performed by unlicensed offices.

In a news release, Brad Bennett, Maxim’s chief executive, said the company takes “full responsibility” for the charges outlined in the deferred prosecution agreement.

The investigation of Maxim stemmed from a whistleblower lawsuit filed under the U.S. False Claims Act by a 63-year-old New Jersey man with muscular dystrophy. He said that Maxim claimed more than 700 hours of services over a 15-month period in 2003 and 2004 that never were provided. He will collect a $15.4 million award under the act, which is intended to encourage people to report fraud.

“It is our hope that Maxim, in cleaning up its own house, will be a lighthouse influencing best practices across the industry,” J. Gilmore Childers, New Jersey’s acting United States attorney, said in a news release.


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