Insurance company did not follow applicable rules when setting rates, it
charged for healthcare benefits under its Federal Employees health Benefits
Program (FEHBP) contracts, and failed to give the healthcare program the same
discounted rates it gave similarly situated commercial customers.
It also
failed to coordinate FEHBP benefits with those provided to Medicare eligible
annuitants and submitted statements to the Office of Personnel Management (OPM)
that failed to fully disclose rate adjustments due to FEHBP.
Fraud
Waste
Abuse
Neither
2. The state
of California and the county of Los Angeles billed Medicaid for services
provided to minors when those jurisdictions had no basis for concluding that
these individuals financially qualified for Medicaid services. The services at
issue in this matter were treatment for drug and alcohol abuse, pregnancy and
pregnancy-related services, family planning, sexual assault treatment, sexually
transmitted diseases treatment, and mental health services.
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