Source: Office of United States Attorneys
SAN JUAN, Puerto Rico – The United States Attorney for the District of Puerto Rico and the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG) announce that MMM Holdings, LLC. (MMM) has agreed to pay $15,228,340 to resolve False Claims Act allegations that it implemented a gift card incentive program in violation of the Anti-Kickback Statute.
According to the settlement agreement, the United States asserted that MMM submitted or caused to be submitted claims for payment to the Medicare Program relating to a gift card incentive scheme implemented by MMM during the period of January 2018 to December 2022, which the United States alleged violated the Anti-Kickback Statute, and which resulted in violations of the False Claims Act. As a result of the incentive scheme, the United States alleged that MMM distributed gift cards to administrative assistants of providers to induce the referral, recommendation, or arrangement for enrollment of thousands of Medicare beneficiaries in an MMM Medicare Advantage plan. Those newly enrolled Medicare beneficiaries resulted in associated premium payments of $6,091,336. The negotiated settlement with MMM took into consideration the company’s cooperative efforts and implementation of internal controls.
In connection with the settlement, MMM entered into a five-year Corporate Integrity Agreement (CIA) with the Department of Health and Human Services Office of Inspector General (HHS-OIG) that requires, among other conditions, that MMM create procedures designed to ensure that any new or existing marketing arrangements do not violate the Anti-Kickback statute. MMM must also engage an Independent Review Organization to review the systems that MMM has in place to track such arrangements and to review a sample of the arrangements each year of the CIA.
This agreement underscores the commitment of the Justice Department and HHS-OIG to deter fraud, waste, and abuse in federal benefit programs. “Investigating healthcare fraud remains a high priority in the Department of Justice and the United States Attorney’s Office will aggressively pursue those that violate the healthcare laws of the United States”, said United States Attorney W. Stephen Muldrow. “In this case, we appreciate MMM’s cooperation during the investigation and willingness to promptly negotiate a resolution in this matter.”
Naomi Gruchacz, the Special Agent in Charge of the New York Regional Office of the Department of Health and Human Services, Office of Inspector General, said “Medicare Advantage plans that engage in improper financial arrangements undermine the integrity of the Medicare program and place profits ahead of enrollees’ best interests. HHS-OIG will continue to coordinate with our law enforcement partners to identify and investigate such allegations in order to protect federal health care programs and the Americans who rely on them.”
This matter was prosecuted by Assistant U.S. Attorney Rafael J. López-Rivera, Civil Health Care Fraud Coordinator, at the U.S. Attorney’s Office, in coordination with the U.S. Department of Health and Human Services, Office of Inspector General and the collaboration of the Federal Bureau of Investigation.
The United States Attorney’s Office encourages anyone with information involving waste, fraud, and abuse in federal healthcare or other programs, to please report the illegal conduct, by contacting:
HHS-OIG Hotline: 1-800-HHS-TIPS (1-800-447-8477) or https://tips.oig.hhs.gov
To file a voluntary self-disclosure, please access the link below:
https://oig.hhs.gov/compliance/self-disclosure-info/self-disclosure-protocol/
You may also contact the FBI at (202) 324-3000, or online at www.fbi.gov or tips.fbi.gov.
The settled civil claims are allegations only and MMM did not admit liability as part of this settlement agreement. Further, there has been no determination of civil liability.