According to a press release by the U.S. Attorney for the Eastern District of Pennsylvania, Keystone Mercy Health Plan has agreed to pay $5 million to resolve civil liabilities under the federal False Claims Act and other federal and state statutes and common law principles. According to the complaint filed by the U.S. Attorney, KMHP allegedly violated the federal False Claims Act by failing to remit to the Pennsylvania Department of Public Welfare overpayments recouped by KMHP from providers. Of note is the fact that the case was initiated by a former employee of KMHP under the whistleblower provisions of the False Claims Act. According to the complaint, the whistleblower stands to receive $780,000 from the settlement proceeds.
