MCS Advantage will pay $4.2 million for gift card program investigated by federal prosecutor

The insurer MCS Advantage agreed with federal authorities to pay $4.2 million to resolve allegations that it used gift cards to get medical office staff to find new subscribers for its health plan. MedicareAdvantage.

This was announced today by the federal prosecutor’s office in Puerto Rico, in a statement issued jointly with the Office of the Inspector General and the United States Department of Health.

The United States government reportedly alleged that the insurer MCS Advantage submitted payment claims to the Medicare program that were related to a gift card incentive program that resulted in violations of the False Claims Act and to the statute that prohibits illegal commissions (Anti-Kickbacks).

During the aforementioned program, which was implemented between November 2019 and December 2020, MCS distributed 1,703 gift cards to administrative assistants of health providers, with an added cost of $42,575.

The objective, according to the federal statement, was to induce these personnel to refer, recommend or arrange for 1,646 Medicare beneficiaries to become subscribers of the MCS Medicare Advantage plan.

“Investigating health care fraud remains a high priority at the Department of Justice and the United States Attorney’s Office, and we will aggressively go after those who violate America’s health care laws,” he said. in writing, the federal prosecutor assigned to the District of Puerto Rico, W. Stephen Muldrow.

In reaching the agreement, the federal agencies involved stated that they were committed to deterring and stopping fraud, waste and abuse of federal programs. The benefits of cooperating with federal investigations were also highlighted, since the remedy negotiated took into consideration that MCS Advantage voluntarily terminated the gift card program in December 2020disclosed relevant facts about its program, and implemented controls and reviews of its internal policies to ensure compliance going forward.

The federal prosecutor’s office clarified that As part of the negotiation, MCS Advantage did not admit responsibility for the investigated allegations, which were duly resolved through the agreement announced today..

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