Indiana Medicaid Whistleblower Complaint Accuses Four Managed Care Plans & Six Health Systems Of Fraud

A whistleblower lawsuit amended and unsealed in August 2024 accuses four Indiana Medicaid managed care organizations (MCOs) and six health systems of Medicaid fraud. The complaint alleges that the health systems submitted improper claims and that the MCOs paid them knowing that higher expenditures in their encounter data would increase their capitated rate in the future.

The lawsuit presents three types of false claims submitted by the health systems:

Claims related to readmissions, hospital transfers, and 24-hour stays. The health systems allegedly filed two separate inpatient claims when a beneficiary was readmitted within 72 hours for the same condition . . .