Lawsuit Against PCG: Allegations That PCG is Inept and Malicious!

It seems that Public Consulting Group’s (PCG) unscrupulous behavior has no bounds.

On June 6, 2013, LDP, Inc. d/b/a Leader Services sued PCG in the Eastern District of Pennsylvania.  (Case No.: 2:13-cv-03128-AB).

According to the Complaint, Leader and PCG are direct competitors.  Leader was the Pennsylvania’s Department of Education (DOE) contractor responsible for executing Medicaid claims for the school-based ACCESS program.  In 2011, the Pennsylvania DOE requested bids from companies.  PCG won the bid by submitting a bid at less than half the amount paid under previous years. (Already fishy).

Many school agencies were concerned about the switch from Leader’s computer program to PCG’s program.  Leader offered to serve as an intermediary during the switch.

Leader alleges that PCG took active steps to thwart Leader’s intermediary role, such as changing its data formatting and not paying claims submitted by Leader.  The biggest allegations is that PCG failed to process hundreds of thousands of claims for Medicaid payments submitted by Leader, which resulted in tens of millions of dollars of health-related services provided by school agencies to go unpaid.

The press got wind and some stories were written about PCG doing a “poor job.”

PCG turned around and began disparaging Leader.  PCG held conference calls and meetings asserting that the schools were not paid because of Leader, not PCG.  Leader confronted PCG and PCG provided (for the first time) error logs (basically a log of why the claims were unpaid and as a basis for the disparaging remarks that the claims were not paid because of Leader).

Leader reviewed the error logs, only to discover that the majority of “errors” were errors because of PCG!!! (Hmmmm..sound familiar?).

What???? PCG erroneously auditing something?  Say it is not so!! (This is sarcasm, people).

After seeing how PCG conducted itself in New Mexico (auditing 15 behavioral health care providers at the request of HSD, but after flying to Arizona to determine which companies should take over the 15 providers, and never showing the providers the claim audit findings) and how PCG is conducting itself in North Carolina (sending providers Tentative Notices of Overpayment saying the provider owes hundreds of thousands, if not millions of dollars, only to discover that the PCG auditors were wrong and the provider really owes a $100), I cannot say I am surprised that PCG would fail to process claims, blame Leader, and produce a report supposedly showing Leader’s errors, but, in reality, the errors being on PCG shoulders.

No. Not surprising.

Although, remember, this is a Complaint.  The courts have not rendered a decision.  There is a chance that Leader made all this up….there is also a chance that PCG is inept and malicious.

Leader sued PCG for

1. Tortious interference with contract;

2. Unfair competition;

3. Commercial disparagement; and

4. Defamation.

Coincidentally, some of the cause of action would be the very same causes of action I would advise the NM behavioral health care providers to assert.

About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on September 13, 2013, in Behavioral health, Division of Medical Assistance, Extrapolations, Health Care Providers and Services, Injunctions, Lawsuit, Legal Analysis, Legal Remedies for Medicaid Providers, Medicaid, Medicaid Funds, Medicaid Services, Mental Health, Mental Health Problems, Mental Illness, Monetary Damages, NC DHHS, New Mexico, North Carolina, Public Consulting Group and tagged , , , , , , , , , , , , , , , . Bookmark the permalink. 1 Comment.

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