CareCore to Pay $54M in Resolving Medicare-Medicaid Fraud Case

Health benefits management company CareCore agreed to pay $54 million to settle a whistle-blower case alleging that it bilked Medicare and Medicaid by automatically approving radiology services as medically necessary without making a proper evaluation (United States ex rel. Miller v. CareCore National LLC, S.D.N.Y., 1:13-cv-01177, settlement 5/11/17).

The U.S. and 20 states joined in the whistle-blower lawsuit under the federal False Claims Act and will share the amount paid by CareCore National LLC, now a part of Bluffton, S.C.-based eviCore healthcare. The settlement between the governments and the company was approved May 11 by Judge Richard J. ...