OMIG-Assisted Investigation of Excluded Provider, Referral Leads to $7.6 Million Medicaid Settlement

An OMIG-assisted investigation of an excluded social worker participating in the state's Medicaid program and subsequent referral to state prosecutors lead to a $7.6 million Medicaid settlement last week between the state and the Medicaid managed care organization that had contracted with the excluded social worker for services.

As announced by the Attorney General's office Sept. 12, Fidelis Care billed Medicaid for services provided by Cornerstone Herkimer, LLC from February 2019 to July 2021, even though the company's sole owner and director, Licensed Clinical Social Worker Ward Halverson, had previously lost his license and was excluded from the Medicaid Program in May 2017.

Under the settlement, Fidelis Care agreed to pay back the more than $7.6 million in improper Medicaid payments to the Medicaid program and, as required, perform systematic status checks of those Medicaid providers it contracts with against federal and state lists of providers excluded from Medicaid, and terminate any prohibited relationships identified during its reviews.

Read more about this settlement and OMIG's efforts