CSC Sued in NY: Accused of Multi-Million Dollar Healthcare Fraud Scheme!!

Remember the NCTracks lawsuit?  NCTracks Derailed: Class Action Lawsuit Filed!!  Computer Sciences Corporation (CSC) is one of the Defendants in that action here in NC.

Well, Monday CSC was hit with another enormous lawsuit.  This one is filed in New York, and the Plaintiff is the U.S. Federal Government.

The feds are accusing CSC of a multi-million dollar Medicaid fraud scheme through its Medicaid billing software CSC implemented in NY.

Here is the press release.

From the complaint: “[T]hese fraud schemes were far from isolated events; instead, they were part and parcel of a general practice at CSC and the City to blatantly disregard their obligations to comply with Medicaid billing requirements.” (Compl. par. 8.)

The feds are seeking treble damages, which permits a court to triple the amount of the actual/compensatory damages to be awarded to a prevailing plaintiff.

According to the lawsuit, CSC has received millions of taxpayer dollars (budgeted for Medicaid) unlawfully and in direct violation of federal billing requirements.

If I were a taxpayer in NY, I would be incensed!!!! If I were a Medicaid recipient of parent of a child receiving Medicaid services, I would be furious!!

Now, take a step back…who is administering our Medicaid billing system here in NC?

Answer: CSC

This will almost certainly cause the federal government to peer a bit closer at all CSC’s billing software systems in other states…

About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on October 29, 2014, in Accountability, Computer Sciences Corporation, Credible Allegations of Fraud, CSC, Division of Medical Assistance, False Claims, False Claims Act, Federal Government, Federal Law, Fraud, Health Care Providers and Services, Lawsuit, Legal Analysis, Legal Remedies for Medicaid Providers, Medicaid, Medicaid Attorney, Medicaid Fraud, Medicaid Providers, Medicaid Recipients, NC, NC DHHS, NCTracks, NCTracks Billing Issues, New York Medicaid, North Carolina, Tax Dollars, Taxes, Taxpayers, Washington D.C. and tagged , , , , , , , , , , , , , , , , , , , , , , . Bookmark the permalink. 5 Comments.

  1. I believe it is the provider who should be incensed. The care is still being provided, yet denied by CSC. As in the case of trying to get some procedures paid here in NC, that are on the fee schedule paid. CSC advised today “just because it’s on teh fee schedule doesn’t mean it’s payable”. Then providers have to write it off….

    • Actually, Robyn, I was just talking to someone else and the providers in NY came up. I think you are absolutely right. The providers are suffering. Are you serious that CSC advised today that just because its on the fee schedule doesn’t mean it’s payable??? Are you kidding? In NC, CSC is supposed to be the billing agent, not provide utilization review as to the viability of the claim.

      • Robyn, Can you describe the details surrounding that comment from CSC?

      • Good Afternoon Knicole,

        It all started with the 99239 (hospital discharge) being done by an NP. Claims were denied as “This provider type/provider specialty may not bill this service.”. Then the June 2014 Medicaid Bulletin advised “system issues have been changed to correct this issue and add physician assistants to the above codes” and claims could be refiled. We did, and they are now being denied for taxonomy codes.

        Now I am receiving denials for procedure code 99217 (observation discharge) being done by an NP. Again they are being denied as “This provider type/provider specialty may not bill this service”, although it, too , is on the NP fee schedule.

        Upon asking for a claims review on the 2 denied, one is still under review, and the other was returned by claims stating “the denial stands”. When I told the girl I was speaking with about the other claim still being reviewed and that the procedure code was on the fee schedule she advised “just because it is on the fee schedule doesn’t mean it is going to be paid”.

        I am able to supply to you names, CSI numbers, interaction numbers AND copies of emails explaining the denials due to taxonomy codes.

        So I asked for fee schedules by taxonomy code… I’m sure you know the answer I received.

        Please feel free to email me if you would like additional information.

      • Thank you! Interesting!

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