Benefits Co. Ends FCA Suit Over Prior Approvals For $54M

Law360, New York (May 12, 2017, 3:03 PM EDT) -- A benefits management company will cough up $54 million to end a whistleblower's False Claims Act suit accusing it of pretending to verify the medical necessity of treatment for patients in Medicare Advantage and Medicaid, the U.S. Department of Justice said Thursday.

The settlement stems from at least 200,000 bogus prior authorizations performed from 2005 to 2013 by CareCore National LLC, now known as EviCore Healthcare. As part of Thursday's deal, the company "admitted and accepted responsibility for" the conduct, something that the DOJ has increasingly insisted upon in FCA settlements.

According to court documents, CareCore processed millions of prior authorizations...

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