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Whistleblower Claims Medicaid Managed Firm Repeatedly and Improperly Denied Care

This fall, an executive at SynerMed, one of the largest physician-practice management firms in the nation, provided a report to her bosses that detailed how the company had improperly denied care to thousands of Medicaid patients and developed a system of falsifying documents to hide the evidence.

The confidential report stated that the violations were widespread and “systemic in nature.” The same report was later sent to California health officials anonymously. Within a matter of weeks, state regulators launched an investigation involving surprise audits and resulting in the closure of the firm.

Jennifer Kent, director of health services and Medicaid for California, said she was able to confirm “widespread deficiencies” at SynerMed, which managed care for more than 650,000 Medicaid recipients throughout the state.

SynerMed also oversaw managed care services for Medicare patients and people with commercial insurance, dealing with a total of 1.2 million patients. Its role grew significantly after the expansion of Medicaid under the Patient Protection and Affordable Care Act of 2010.

Report makes a considerable impact

The whistleblower’s findings raised concern throughout the state and brought forth questions as to how these problems could have gone unnoticed for so long. Many say it is a sign of a lack of accountability for businesses and organizations that deal with Medicaid managed care. These entities often receive millions in taxpayer dollars.

With the report and its fallout still being so recent, it is difficult to say how the findings will affect California healthcare policy in the long term. However, it is yet another example of the importance of whistleblowers in finding and reporting instances of healthcare fraud that cost taxpayers large sums of money.

If you have questions about how you might proceed with a whistleblower compliant, work with an experienced Dallas lawyer at Whistleblower Law for Managers.

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