Pediatric Services of America to Pay $1.4M False Claims Settlement to State

Staff Report From Georgia CEO

Wednesday, August 5th, 2015

Attorney General Sam Olens announced that Georgia has joined with other states and the federal government to settle allegations that Pediatric Services of America Healthcare, Pediatric Services of America, Inc., Pediatric Healthcare, Inc.; Pediatric Home Nursing Services (collectively, “PSA”) and Portfolio Logic, LLC violated the federal False Claims Act and the Georgia False Medicaid Claims Act by knowingly (1) failing to disclose and return overpayments that it received from federal health care programs such as Medicare and Medicaid, (2) submitting claims under the Georgia Medicaid Pediatric Program for home nursing care without documenting the requisite monthly supervisory visits by a registered nurse, and (3) submitting claims to federal health care programs that overstated the length of time their staff had provided services.  PSA agreed to pay the states and the federal government $6,882,387, of which the Georgia Department of Community Health will receive $1,426,316.

The settlement was the result of a joint investigation by the Georgia Medicaid Fraud Control Unit of the Attorney General’s Office, the United States Attorney’s Office for the Northern District of Georgia, the United States Attorney’s Office for the Southern District of Georgia, the United States Department of Health & Human Services, the United States Department of Defense, and a team from the National Association of Medicaid Fraud Control Units, comprised of representatives from Massachusetts, Georgia, Virginia, Texas, Illinois, and Washington.  At the government’s request, PSA cooperated with a joint audit of the credit balances on its books in order to identify all allegedly outstanding overpayments.  The claims settled in the civil settlement are allegations only, and there has been no determination of liability.

“Healthcare providers enrolled in the Georgia Medicaid program are entrusted to use taxpayers’ money appropriately and responsibly to provide care and treatment for eligible patients, in this case medically fragile children,” said Georgia Attorney General Sam Olens.  “If providers do not uphold this critical responsibility, they will be held accountable.  My office will continue to collaborate with our federal partners to ensure that every Georgia Medicaid dollar is spent as intended.”

As a condition of the settlement, PSA has agreed to enter into a corporate integrity agreement with the United States Department of Health & Human Services, Office of Inspector General.

The settlement resolves allegations filed by Yvette Odumosu and Sheila McCray, former employees of PSA, under the qui tam or whistleblower provisions of the False Claims Act and the Georgia False Medicaid Claims Act, which authorize private parties to sue for false claims on behalf of the United States and the State of Georgia and share in the recovery. Ms. Odumosu’s lawsuit was filed in the Northern District of Georgia and is captioned U.S. ex rel. Yvette Odumosu v. Pediatric Services of America Healthcare, No. 1:11-CV-1007-AT, and Ms. McCray’s lawsuit subsequently was filed in the Southern District of Georgia and is captioned United States ex rel. Sheila McCray, et al. v. Pediatric Services of America, Inc., Pediatric Services of America, Pediatric Healthcare, Inc.; Pediatric Home Nursing Services, collectively d/b/a PSA Healthcare; and Portfolio Logic, LLC, No. CV413-12.  Ms. Odumosu and Ms. McCray will collectively receive $280,800.83 as their share of Georgia’s recovery.

The civil settlement was reached by Assistant Attorney General Elizabeth White, Assistant United States Attorneys Neeli Ben-David, Darcy Coty and Charles Mulaney, and Assistant Attorney Generals from the other states on the NAMFCU team.  Georgia MFCU Assistant Attorney General Jim Mooney, Investigator Tonia Medlin, Investigative Auditor Kenyetta Smith, and Analyst Kirste Young investigated the case in conjunction with federal agents.