MCS Advantage to pay $4.2 million to gift card scheme investigated by federal prosecutors

Insurer MCS Advantage has agreed to pay $4.2 million with federal authorities to settle allegations that it used gift cards to get medical office workers to find new subscribers to its health plan. Medical benefit.

The Office of the Federal Attorney for Puerto Rico made the announcement today in a statement released jointly with the Office of the Inspector General and the United States Department of Health.

The U.S. government alleged that the insurer submitted claims for payment to the MCS Advantage health insurance plan in connection with the gift card incentive program, resulting in violations of the False Claims Act and the Anti-Kickback Act.

During the above scheme implemented between November 2019 and December 2020, MCS distributed 1,703 gift cards to administrative assistants of healthcare providers, With an additional cost of $42,575.

According to the federal report, these employees were motivated to convert, refer or arrange for 1,646 Medicare beneficiaries to become subscribers to the MCS Medicare program.

“Investigating health care fraud is a high priority for the Department of Justice and the United States Attorney’s Office, and we will aggressively pursue those who violate America’s health care laws,” he wrote to the federal prosecutor assigned to the District of Puerto Rico. Rico, W. Stephen Muldrow.

In reaching the agreement, the federal agencies involved pledged to prevent and stop fraud, waste and abuse of federal programs. Since the settlement was negotiated, the benefits of cooperating with federal investigations have also been highlighted MCS Advantage voluntarily discontinued the gift card program in December 2020Disclose relevant facts about its program, and implement controls and reviews of its internal policies to ensure compliance.

The central government attorney’s office has clarified that As part of the settlement, MCS Advantage has accepted no liability for the allegations under investigation, which have been formally resolved through the settlement announced today..