The state has reached a settlement with Fidelis Care (Fidelis) for causing vulnerable Medicaid patients in Central New York to receive treatment at a company owned by a social worker who had previously lost his license after being convicted of a crime.
According to the Attorney General’s Office, Fidelis billed Medicaid for services provided by Cornerstone Herkimer, LLC (“Cornerstone”), even though the company’s sole owner and director, Licensed Clinical Social Worker Ward Halverson, had been excluded from the Medicaid Program. Halverson was banned from being a Medicaid provider in 2017 after being convicted of a misdemeanor for firing a BB gun at a child. Under the settlement, Fidelis will pay back more than $7.6 million in reimbursements to the Medicaid program. Fidelis also agreed to perform systematic status checks of those it contracts with against federal and state lists of providers excluded from Medicaid and terminate any prohibited relationships identified during its reviews.
“New Yorkers should be able to trust that the doctors and health care providers their insurers use are properly licensed and will treat them responsibly,” said Attorney General James. “When companies fail to do their due diligence, patients are at risk of being treated by providers who may be unlicensed or unsafe. This settlement sends a clear message that insurers will be held accountable if they do not ensure those in their networks are legally allowed to treat vulnerable Medicaid patients.”
As a result of the Office of the Attorney General’s (OAG) action, Fidelis must repay the state Medicaid program $7,681,796.44. Fidelis will also have to determine the identity and exclusion status for all of its participating providers, subcontractors, and anyone with an ownership or managing role as a participating provider or subcontractor. Fidelis is then required to terminate its provider agreements with any excluded person and their businesses.
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