Under Medicaid nationally, 79 percent of all spending is for 40 percent of beneficiaries with multiple chronic conditions. Disease management programs therefore are a critical component for controlling Medicaid expenditures. However, a Georgia initiative in disease management stumbled recently when its contractor, Innovative Resources Group LLC, a subsidiary of APS Healthcare, settled a lawsuit alleging violations of the Federal False Claims Act. The suit was filed in the Northern District of Georgia under the qui tam, or whistleblower, provisions of the False Claims Act. The $13 million settlement will be shared among the United States ($5.2 million), the State of Georgia ($7.8 million) and Michael Claeys, a former APS executive director who “blew the whistle” by filing suit against APS.
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