West Virginia settles with hospital over Medicaid fraud allegations

(The Center Square) – A West Virginia hospital accused of improperly billing Medicaid for two years will pay the state more than $300,000 in a settlement, West Virginia Attorney General Patrick Morrisey announced this week.

The $320,175 settlement, Morrisey said in a news release, resolves allegations Grant Memorial Hospital in Petersburg billed Medicaid for services a physician was not credentialed to provide. The hospital disclosed the issue to authorities.

“Grant Memorial Hospital did the right thing by catching this fraud and reporting it,” Morrisey said. “Fighting fraud takes a team approach. We encourage anyone who suspects Medicaid fraud to report it. Such theft takes resources from those who need it most, and that underscores why our office remains dedicated to fighting fraud, waste and abuse.”

The self-reporting and investigation from the attorney general’s Medicaid Fraud Control Unit and the U.S. Department of Health and Human Services said Dr. Amanda Borror was not credentialed to provide certain services when she began working at the hospital in September 2014, according to the news release.

Investigators said Borror provided services under the National Provider Identifier of another physician, and Grant Memorial named that physician as the rendering provider. Borror also used the physician’s login credentials to access electronic health records for outpatient services, an attempt to make it appear he had provided services and signed notes that actually were completed by Borror.

Morrisey said the state will be receiving more than $86,000 from the settlement, with the rest going to reimburse federal Medicaid programs.

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