MCS Advantage Agrees to Pay 4.2 Million Dollars to Resolve Allegations that it Violated the False Claims Act and Anti-Kickback Statute | USAO-PR

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SAN JUAN, Puerto Rico – On July 1st, 2022, the United States Attorney for the District of Puerto Rico and the U.S. Department of Health and Human Services, Office of Inspector General (HHS- OIG) announced that MCS Advantage, Inc. (MCS Advantage) has agreed to pay $4,200,000 to resolve False Claims Act allegations that it implemented a gift card incentive program in violation of the Anti-Kickback Statute.

According to the settlement agreement, the United States asserted that MCS Advantage submitted or caused to be submitted claims for payment to the Medicare Program relating to a gift card incentive program implemented by MCS during the period of November 2019 to December 2020, which the Government alleges resulted in violations of the False Claims Act and the Anti-Kickback Statute. As a result of the incentive program, MCS distributed 1,703 gift cards to administrative assistants of providers at an aggregate cost of $42,575 to induce the assistants to refer, recommend, or arrange for enrollment of 1,646 new Medicare beneficiaries to an MCS Medicare Advantage plan. Those new Medicare beneficiaries resulted in associated premium payments received by MCS Advantage for the new members.

This agreement underscores the commitment of the Justice Department and HHS- OIG to deterring fraud, waste, and abuse of federal benefit programs, as well as the benefits of cooperation with federal investigations. The negotiated settlement with MCS Advantage took into consideration the company’s voluntary termination of the gift card program in December 2020, the disclosure of relevant facts concerning the program, and the implementation of controls and revisions to its internal policies to promote and help ensure future compliance.

“Investigating healthcare fraud remains a high priority in the Department of Justice and the United States Attorney’s Office and we will aggressively pursue those that violate the healthcare laws of the United States”, said United States Attorney Muldrow. “In this case, we appreciate MCS Advantage’s willingness to promptly negotiate a resolution in this matter.”

Special Agent in Charge Scott J. Lampert of the U.S. Department of Health and Human Services, Office of Inspector General New York Region said, “HHS-OIG will continue to investigate any conduct by Medicare Advantage plans that may result in violation of federal law and will work jointly with our law enforcement partners to ensure that entities that conduct business with federal health care programs do so in an honest manner.”

The settled civil claims are allegations only and MCS Advantage did not admit liability as part of this settlement agreement. Further, there has been no determination of civil liability.

This matter was prosecuted by Assistant U.S. Attorney Rafael J. López Rivera, Civil Health Care Fraud Coordinator, at the U.S. Attorney’s Office, in coordination with the U.S. Department of Health and Human Services, Office of Inspector General.

The claims resolved by the settlement are allegations only and there has been no determination of liability.



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