Health Net Federal Services Pays over $97M for Overstated Billings to the VA
SACRAMENTO, CA (STL.News) Health Net Federal Services LLC has paid $97,237,391 to resolve duplicate and inflated claims submitted to the Department of Veterans Affairs, Acting U.S. Attorney Phillip A. Talbert announced.
In 2013, Health Net entered a $5.05 billion contract with the VA under the Patient-Centered Community Care program, which offered private health care to veterans when VA facilities could not do so in a timely manner. The Veterans Access, Choice and Accountability Act of 2014 expanded the services to cover veterans who waited more than 30 days for care or lived more than 40 miles away from a VA medical facility. Under this contract, Health Net served as the third-party administrator that secured private health care for veterans, reimbursed these providers for services to veterans, and in turn billed the VA for the services.
In 2017, the VA Office of Inspector General (VA OIG) audited Health Net and found evidence suggesting the company had billed the VA for duplicate claims amounting to approximately $30 million and failed to reduce billings to the VA for approximately $1 million in provider rate savings, as contractually required.