OKLAHOMA CITY – Tri-State Medical Supplies will pay $363,116 in a pre-lawsuit settlement to resolve allegations that the company inflated prices and shipping charges for medical equipment, a violation of the Oklahoma Medicaid False Claims Act, state Attorney General John O’Connor announced Friday.
Tri-State, formerly based in Oklahoma, provided medical equipment and other services to Oklahoma Medicaid beneficiaries through a program of the state Department of Human Services’ Disabilities Services Division, O’Connor said. The settlement resolves allegations that Tri-State submitted claims based on inflated prices and shipping charges to SoonerCare, which is Oklahoma’s Medicaid program.
The state’s Medicaid Fraud Control Unit launched an investigation of Tri-State after receiving a referral from a program manager in DHS’ Disabilities Services Division, O’Connor reported. The program manager became suspicious when Tri-State’s claims were compared to claims from other companies that provided similar equipment and services, the Attorney General said.
“I commend our Medicaid Fraud Control Unit for successfully investigating this case and OKDHS’ Developmental Disabilities Services Division for their employee’s referral,” O’Connor said.
MFCU agents conducted the investigation, and Assistant Attorney General Christopher Robinson obtained the settlement.
In accordance with state law, the settlement apparently will be divided between the Oklahoma Health Care Authority, which administers the state’s Medicaid program, and the Attorney General’s Office.
Any portion of the settlement that was designated as restitution will be returned to the OHCA, while the A.G.’s office will be compensated for the costs of investigation, litigation, attorney fees and other expenses, and some will be routed to the agency’s Medicaid Fraud Revolving Fund, Madelyn Hague, O’Connor’s press secretary, told Southwest Ledger.
The MFCU investigates and prosecutes cases involving provider fraud in the administration of Oklahoma’s Medicaid program. The unit also investigates whistleblowers’ allegations in Oklahoma and across the country, working with MFCUs in other states and U.S. attorneys’ offices.
In addition, the unit investigates and prosecutes cases of abuse, neglect, drug diversion and financial exploitation involving residents of long-term care facilities or, in some circumstances, residential care settings.
The Oklahoma Attorney General’s Office Medicaid Fraud Control Unit receives 75% of its funding from the U.S. Department of Health and Human Services under a grant award totaling $3,424,943 for federal Fiscal Year 2022. The remaining 25%, totaling $856,235 for FY 2022, is funded by the State of Oklahoma. The federal fiscal year extends from Oct. 1, 2021, through Sept. 30, 2022.