A whistleblower case claiming Molina Healthcare overbilled the Illinois Medicaid program will move forward after the U.S. Supreme Court declined to hear a challenge Monday.
It was one of three cases the court declined to hear challenging whether whistleblowers must provide details of false claims act allegations, according to court documents.
In 2017, founder of former Molina contractor GenMed, Thomas Prose, filed a lawsuit in the Northern District of Illinois, alleging the payer sought and obtained compensation despite failing to provide the material services required under its contract.
The payer had previously contracted with GenMed to provide skilled nursing facility services for sick, disabled or elderly patients who need long-term medical and nursing care without hospitalization.
Under the arrangement, patients were divided into tiers based on the level of care needed, with Molina receiving $54 for patients at the lowest tier, and $3,127 for the highest tier of patients living in nursing facilities. Molina received full capitation payments from the government, then paid GenMed an agreed amount, according to the lawsuit.
The contracting arrangement lasted about nine months until Molina tried to renegotiate terms of the contract and GenMed terminated it, according to the suit. The payer received capitation amounts for SNF services after terminating the contract, even though it did not contract with another group to provide SNF services, the suit alleges.
Molina moved to dismiss the lawsuit, arguing Prose hadn’t presented enough detail about the alleged false claims made. U.S. District Judge Virginia Kendall dismissed the case, though Prose appealed.
In August, a federal appeals court found Prose had presented enough material information outlining false claims, allowing the case to move forward.
Tuesday’s move from the Supreme Court further affirms the case can move forward. The high court declined to explain its reasoning in deciding not to hear the cases.
Molina has faced other false claims act violation allegations recently.
In June, the payer and its previously owned subsidiary, Pathways Of Massachusetts, agreed to pay over $4.6 million to settle claims it submitted reimbursements to MassHealth, the state’s Medicaid Program, for services provided by inadequately licensed and unsupervised staff.