In a recent case, a Dayton-based managed health care organization, CareSource, agreed to pay $26 million to settle claims alleging CareSource defrauded the federal government. Two former employees brought whistleblower actions in 2006 accusing CareSource of failing to provide required services under the Medicaid program and submitting false claims requesting reimbursement from the federal government for unrendered services. The whistleblowers filed suit under the federal False Claims Act which allows private individuals to file suit on behalf of the federal government against people or organizations whom they know to be defrauding the government. The federal False Claims Act carries stiff penalties including reimbursement, triple damages, civil penalties of $5,500 to $11,000 per false claim, and possible exclusion from all federal health care programs. Under the law, the whistleblower may be awarded a portion of the funds recovered. From the $26 million CareSource settlement, the whistleblowers will receive $3.1 million, the state of Ohio will receive $10 million, and the federal government will receive the remainder. But Ohio wants more money from these types of suits and may get more if lawmakers act.
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