Managed care organizations contracted with the state are required to terminate their relationships with any provider excluded from the Medicaid program. State and federal law also requires Fidelis to conduct routine checks of exclusion lists.
Fidelis billed Medicaid for patient services from February 2019 to July 2021 from a company owned by a social worker who had previously lost his license in 2017 after being convicted of a misdemeanor for firing a BB gun at a child, according to a Sept. 12 news release.
Under the settlement, Fidelis will pay back more than $7.6 million in reimbursements to the state’s Medicaid program. The company has also agreed to perform routine status checks of its contracts for providers excluded from Medicaid and terminate any relationships identified during those reviews.
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