Behavioral Health Network Issues Lead to $4.6M Fine for Molina

Meeting Medicaid network adequacy requirements for behavioral health providers continues to be a challenge for health insurers, as shown by a recent $4.6 million settlement between Molina Healthcare, Inc., its former behavioral health subsidiary, Pathways of Massachusetts, and the Department of Justice.

In the case, Molina and Pathways of Massachusetts agreed to pay $4.625 million to resolve False Claims Act allegations that they submitted claims to MassHealth — the state’s Medicaid program — while violating regulations governing how staff are licensed and supervised, the U.S. Attorney’s Office for the District of Massachusetts said on June 21. The settlement in the case, which was first brought by four whistleblowers who were Pathways employees, calls for the former employees to receive $810,000.

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Jill Brown Kettler

Jill Brown Kettler Executive Editor

Jill oversees AIS Health’s publications and manages the health editorial staff. She joined AIS Health in 1999, and brings unique skills and energy to the company, along with an intelligent perspective on the forces reshaping the health care industry. She holds a graduate degree in health finance and management from Johns Hopkins University School of Public Health, and was formerly a consultant with Arthur Andersen, where she worked with managed care plans, hospitals and medical groups on financial issues impacting their operations.

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