Bridgeport-based Optimus Health Care Inc., a federally-qualified health center (FQHC), has agreed to a $470,093.93 civil settlement agreement with federal and state agencies to resolve allegations that it submitted false claims to the Connecticut Medicaid program and received overpayments from Medicaid for ineligible services.
As an FQHC, Optimus receives patient revenues and grants from the federal and state governments. The allegations against the company were based on claims submitted to Connecticut Medicaid for dual-eligible beneficiaries ”“ patients who are Medicare beneficiaries and are also eligible for Medicaid coverage. Optimus was accused of submitting false claims to Connecticut Medicaid for dual-eligible beneficiaries between January 2014 and December 2020 with the incorrect Medicare denial codes, which caused Medicaid to pay claims it would have otherwise denied.
The government also alleges that Optimus improperly billed Connecticut Medicaid for group therapy services for qualified Medicare beneficiaries who were not eligible for reimbursement for those services.
Optimus, which operates 23 locations across Connecticut, did not publicly comment on the settlement.
