Health Net Federal Services LLC has paid $97,237,391 to resolve duplicate and inflated claims submitted to the Department of Veterans Affairs, Acting U.S. Attorney Phillip A. Talbert announced.
In 2013, Health Net entered a $5.05 billion contract with the VA under the Patient-Centered Community Care program, which offered private health care to veterans when VA facilities could not do so in a timely manner. The Veterans Access, Choice and Accountability Act of 2014 expanded the services to cover veterans who waited more than 30 days for care or lived more than 40 miles away from a VA medical facility. Under this contract, Health Net served as the third-party administrator that secured private health care for veterans, reimbursed these providers for services to veterans, and in turn billed the VA for the services.
In 2017, the VA Office of Inspector General (VA OIG) audited Health Net and found evidence suggesting the company had billed the VA for duplicate claims amounting to approximately $30 million and failed to reduce billings to the VA for approximately $1 million in provider rate savings, as contractually required. The ensuing investigation confirmed the conduct, and Health Net ultimately repaid $93,682,428 in overpayments, as well as $3,554,963 in interest.
“Providers must be held to the highest standard of care and must rigorously comply with their contractual obligations,” said Acting U.S. Attorney Talbert. “This office is committed to assisting the VA and other agencies of the United States to ensure the integrity of important federal programs, such as those reimbursed by this settlement that will help our veterans.”
“The VA Office of Inspector General is strongly committed to promoting fiscal accountability throughout VA,” said VA Inspector General Michael J. Missal. “This settlement will return funds to VA programs and services that directly benefit our nation’s veterans. I applaud the teamwork and dedication that led to this significant recovery.”
This settlement is the result of work by the U.S. Attorney’s Office for the Eastern District of California and the Civil Division’s Commercial Litigation Branch, with help from the Department of Veterans Affairs Office of Inspector General and the Federal Bureau of Investigation. Assistant U.S. Attorney Catherine J. Swann handled the matter for the United States. The claims settled by this agreement are allegations only, and there has been no determination of liability.