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Health Company Pays $4.625 Million To Resolve False Claims Act Lawsuit


On June 21st, 2022, the United States District Attorneys’ Office for the District of Massachusetts announced a $4.625 million settlement in a major False Claims Act case. The lawsuit—which was initiated by whistleblowers as part of a qui tam claim—was brought against Molina Healthcare, Inc. and one of its former subsidiary companies called Pathways of Massachusetts. Here, our Florida healthcare billing fraud lawyer provides an overview of the enforcement action taken by the Department of Justice (DOJ).

False Claims Act Settlement: $4.625 Million to Resolve False Reimbursements 

Molina Healthcare, Inc. is a multi-billion dollar managed care company with a main headquarters in Long Beach, California. The company provides health insurance coverage policies through Medicare and Medicaid. During the period at issue in this case (2015 to 2018), Molina Healthcare owned and operated a subsidiary company known as Pathways of Massachusetts. Pathways of Massachusetts was made up of a group of mental health care facilities in the Central and Western Massachusetts cities of Worcester and Springfield.

According to the settlement reached by the Department of Justice (DOJ), Molina Healthcare used its subsidiary company Pathways of Massachusetts to make improper claims for reimbursement through the MassHealth system. Notably, MassHealth is responsible for administering the Commonwealth’s Medicaid program. The mental health centers operating in Worcester and Springfield did not provide Medicaid recipients the proper services based on what was actually billed to the public health program.

Whistleblowers Help to Stop Healthcare Billing Fraud 

Similar to many other large scale health billing fraud cases, the False Claims Act lawsuit brought against Molina Healthcare and Pathways of Massachusetts was initially filed by a group of whistleblowers. The False Claims Act is a unique and powerful federal law because it allows individuals to step into the role of the government and to file a lawsuit directly against a contractor that is improperly billing a federal program. Many False Claims Act lawsuits involve health billing fraud. This type of whistleblower lawsuit is known as a qui tam action.

One of the key things to know about qui tam lawsuits is that they allow whistleblowers to obtain a percentage of the ultimate recovery as an award if the claim is successful. Depending on the circumstances, the whistleblower award could be anywhere between 10 percent and 30 percent of the recovery. As part of the False Claims Act settlement reached by Molina Healthcare and Pathways of Massachusetts, the whistleblower portion of the case has also been resolved. Whistleblowers will receive an undisclosed portion of the federal government’s $4.625 million recovery. 

Speak to Our Whistleblower Attorney for Immediate Help

At Guttman, Freidin & Celler, our whistleblower rights lawyers are standing by, ready to help you bring a False Claims Act lawsuit. If you have any questions about qui tam claims, we are here as a legal resource. Give us a call now or contact us online to set up a no cost, no obligation review of your case. We provide nationwide legal representation in federal False Claims Act lawsuits.


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