National Medicaid Fraud Case Centered in Columbia

A $150 million settlement has been reached in a federal fraud case in which a Columbia-based health care staffing agency admitted to filling out fake billing forms and time sheets to receive millions in unearned Medicaid funds.

was accused by the U.S. Attorney’s Office in New Jersey, among other agencies, of defrauding federal benefits programs of more than $61 million. The company says it has since instituted reforms in its billing practices.

was charged in U.S. District Court in New Jersey Monday, and was accused of defrauding health care benefit programs from 2003 through 2009, according to the criminal complaint.

Maxim’s mission is to provide staffing of care providers to facilities such as hospitals, nursing homes, schools and in-home care residences, according to federal officials.

The Columbia-based company's fraudulent billings to government health care programs were for services that were not rendered, according to the criminal complaint.

In order to do this, company officials are accused of creating fake or modified timesheets to support billings for services that were not completed, as well as falsifying the qualifications of caregivers.

“Maxim, including senior executives, defrauded a system providing needed services to turn money meant for patient care into corporate profits,” said Acting New Jersey U.S. Attorney J. Gilmore Childers.

“We will continue to prove our commitment to investigating and prosecuting both companies and individuals whose misconduct robs our nation’s health care programs and those who count on them. It is our hope that Maxim, in cleaning up its own house, will be a lighthouse influencing best practices across the industry.”

The company entered into a deferred prosecution agreement, which means it must pay $20 million in criminal penalties and $130 million in civil settlements, as well as meet reform requirements.

Those include a corporate integrity agreement with the Office of Inspector General within the U.S. Department of Health and Human Services to promote compliance with federal health care laws and provisions.

In a press release, Maxim CEO Brad Bennett said he is “pleased” to reach a settlement.

“We take full responsibility for these events set forth in the [agreement], and we are pleased to reach a settlement that will allow us to move forward with the important work of caring for our patients and clients who depend on us each and every day,” he said.

According to a Maxim press release, since 2009, the company’s reforms included the:

-       Firing of senior executives and employees responsible or associated with the misconduct.

-       Establishing the position of chief compliance officer, who is responsible for management of company compliance and ethics.

-       Offering more training for staff.

-       Adding new software systems to support federal compliance and patient care.

-       Restructuring compensation structure to recognize excellence in a variety of areas, including clinical outcomes and compliance.

The company is based at 7227 Lee Deforest Drive in Columbia, and has locations in hundreds of offices across the country, according to its website.

The case was prosecuted in New Jersey because a whistleblower first brought the issue to light by filing a civil suit in New Jersey,  according to New Jersey's U.S. Attorney's Office spokeswoman Rebekah Carmichael

Several company officials were also prosecuted as part of the federal  investigation; none of them were from Columbia.