Nebraska Attorney General Doug Peterson announced today that his office has settled a lawsuit with an Omaha area mental health provider concerning false claims that the provider submitted to Nebraska Medicaid and its managed care contractors.
Between September 1, 2013 and December 31, 2018, Kathleen Wiley and her business, Kathy Wiley, LLC submitted 1201 claims for mental health services to Medicaid.
Medicaid paid Wiley $109,274.37 for those services. The state alleged that Wiley failed to maintain proper documentation to prove that the services were actually provided.
The Attorney General filed a civil action against Wiley for violating Nebraska’s False Medicaid Claims Act, which allows the state to recover triple the amount that was paid to Wiley. Wiley settled the matter by paying $200,000 to the state.
The matter was initially investigated by Magellan Health (a Nebraska Medicaid contractor) and the Medicaid Program Integrity Unit at the Nebraska Department of Health and Human Services. It was then referred to the Medicaid Fraud and Patient Abuse Unit in the Nebraska Attorney General’s Office for further investigation and legal action.
The Nebraska Medicaid Fraud and Patient Abuse Unit receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $ 1,077,000 for federal fiscal year (FFY) 2021. The remaining 25 percent, totaling $359,000 for FFY 2021, is funded by the State of Nebraska.