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Company enters settlement agreement to resolve claims of Medicaid over-billing

NEW JERSEY – A Boston, Massachusetts, company entered into a settlement agreement with the United States to resolve allegations that it caused improper claims for payment to be made to the U.S. Department of Health & Human Services, Centers for Medicare and Medicaid Services (CMS), according to U.S. Attorney Philip R. Sellinger.

The investigation of Public Consulting Group LLC (PCG) was initiated through the filing of a complaint under the whistleblower provision of the False Claims Act, Sellinger said.

That complaint, which was unsealed on Sept. 26, alleged that PCG was hired by the state of New Jersey in 2005 to administer New Jersey’s “Special Education Medicaid Initiative,” or SEMI program. Under the SEMI program, the state of New Jersey and local school districts could obtain federal funding for providing eligible medical services to Medicaid-eligible students, Sellinger said.

The complaint alleged that PCG caused local school districts to submit claims to CMS for evaluation services that PCG knew or should have known were not covered by Medicaid, Sellinger said.

The settlement agreement resolves common law claims by the United States against PCG for payment by mistake, arising from evaluation service claims submitted by or for New Jersey school districts under the SEMI program from April 23, 2006, through the date of settlement, Sellinger said.

PCG will pay $2.5 million to the United States. Once PCG makes the payment, the case will be dismissed. The relator, or whistleblower, who originally filed suit on behalf of the United States, will receive 21 percent of the settlement amount recovered by the United States, Sellinger said.

The civil settlement agreement, by its terms, is neither an admission of liability by PCG nor a concession by the United States that its claims are not well founded, Sellinger said.

Jay Edwards

Born and raised in Northwest NJ, Jay has a degree in Communications and has had a life-long interest in local radio and various styles of music. Jay has held numerous jobs over the years such as stunt car driver, bartender, voice-over artist, traffic reporter (award winning), NY Yankee maintenance crewmember and peanut farm worker. His hobbies include mountain climbing, snowmobiling, cooking, performing stand-up comedy and he is an avid squirrel watcher. Jay has been a guest on America’s Morning Headquarters,program on The Weather Channel, and was interviewed by Sam Champion.

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