CHARLESTON W.Va. (WVDN) — West Virginia Attorney General Patrick Morrisey on Friday said his office has reached a settlement agreement with Tiero LLC, a Delaware Liability Company for $839,468.41, following an investigation initiated by the Medicaid Fraud Control Unit (MFCU).
MFCU investigators determined that Tiero submitted claims for payment to the West Virginia Medicaid program for at-home COVID-19 test kits that were not eligible for reimbursement because the company was not enrolled as a provider with the Medicaid program at that time. Tiero also submitted the claims under a billing code intended to be used only for antigen testing services performed in a laboratory setting instead of the correct code which applied to at-home COVID tests.
The settlement includes full restitution of $439,468.41 in Medicaid claims identified by the State of West Virginia as being false and fictitious and additional recoveries totaling $400,000.
“Healthcare providers need to know they must use the proper billing codes that accurately reflect the services they render, and only bill for services that are medically necessary,” Attorney General Morrisey said. “Moreover, any healthcare provider that wants to do business with the state Medicaid program and its managed care organizations must be properly enrolled to do so.”
“They have a responsibility to treat patients with competence and compassion while working within the parameters established by the West Virginia Medicaid program,” Attorney General Morrisey added.
In announcing these actions, Morrisey praised the work of the MFCU staff members who handled the case, including Investigator Kelley Mitchell, Fraud Analyst Brooke McArdle and Attorney Stephen Kenney.
Anyone who suspects potential Medicaid fraud or the neglect, abuse, or financial exploitation of incapacitated adults should report information to the Attorney General’s Medicaid Fraud Control Unit tip line at 888-372-8398 or via the Attorney General’s website at ago.wv.gov.
The MFCU—which joined the Attorney General’s Office in 2019—receives 75% of its funding from the U.S. Department of Health and Human Services. The remaining 25% is funded by the State of West Virginia.
Read a copy of the agreement here.
