Miami-Dade School District Investigates $1 Million in Overcharges by Maxim Healthcare By Tod Aronovitz | 05/20/13 | 0 Comment

An internal audit of the Miami-Dade School District shows that students with disabilities may have been overbilled more than $1 million by a Maryland-based healthcare company that provided services to those students.

According to the district’s chief auditor Jose Montes de Oca, an ongoing investigation into Maxim Healthcare Services has escalated concerns that the company, which provides registered nursing, licensed practical nursing and respiratory therapy to hundreds of students with special needs, may have inflated some of its bills.

According to a report presented to the school board on May 9, a random sampling of invoices submitted between 2008 and mid-2011 found that Maxim Healthcare Services:

    • Charged students for services when attendance records show they were actually absent.
    • Elevated billings by charging for more expensive healthcare specialists than needed.
    • Charged for long periods of care when students only needed intermittent services.
    • Lacked documentation to back up its charges.

The district’s investigation began in September 2011 at the request of Superintendent Alberto Carvalho when he and his staff discovered issues with Maxim’s billings during a competitive bidding process. Days after their investigation started, the U.S. Department of Justice announced that Maxim agreed to pay $150 million to settle charges that it was involved in a nationwide scheme to defraud Medicaid out of $61 million in home healthcare services.

Montes de Oca said during the period under scrutiny, questions arose in one-third of the 94 randomly-pulled invoices, which were worth a total of almost $11 million. The school district may seek restitution, according to Superintendent Carvalho.

Rebecca Kirkham, a Maxim spokeswoman, said that the company “has responded by denying the district’s allegations. We continue to review and investigate this matter internally.”

Carvalho continues to work with the school board to conclude the investigation and improve safeguards. Last week, new bids for nursing services were rejected until it is decided how the district will hold vendors more accountable.

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Healthcare or medical billing employees who have inside knowledge of questionable invoices that are submitted for payment to a government agency can file a confidential legal claim under the False Claims Act. By acting as a “whistleblower” in what is known as a “qui tam” lawsuit, a private party may collect between 10 to 30 percent of the amount recovered, depending on how the case is prosecuted.

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