Amerigroup Corporation Settles Healthcare Fraud Case for $225M

The Amerigroup Corporation recently settled claims alleging that it defrauded Illinois’s Medicaid program by not enrolling pregnant women and unhealthy patients in the state’s low income program – something it was required to do. An Amerigroup employee was the first to bring a lawsuit against the company which ended up costing it $225 million.

Profits over patients

Amerigroup Corporation, the Virginia based healthcare company that provides services to those who are financially vulnerable, seniors and people with disabilities through publicly-funded programs, was supposed to enroll low income clients who were unhealthy or pregnant in the Illinois Medicaid program. According to news reports, the company did exactly the opposite by discriminating against those who were eligible for Medicaid benefits. It chose not to enroll them in an effort to increase its profits, but ended up settling the matter for $225 million, plus an additional nine million dollars in legal fees.

The Amerigroup employee who first brought the lawsuit did so because he felt that the company was putting profits over patients. While the company said that it would not admit any wrongdoing in the settlement, it did agree to enter into a corporate integrity agreement with the U.S. Health and Human Services Department in which the company is required to follow a code of conduct to prevent discrimination in its enrollment and marketing practices in the future.

Whistleblower Will Get $56M

The employee who discovered the fraud and initiated the lawsuit will get 25% of the settlement amount, or approximately $56 million. Under a whistleblower, or Qui Tam, lawsuit, the whistleblower can file a lawsuit against a company for fraud on behalf of the government. The government has the option to join the lawsuit, not join the lawsuit, settle it or have it dismissed.

In this case, the government did join the lawsuit and the whistleblower collected 25%. Other whistleblowers have recovered even higher percentages and most tend to receive hefty sums as these types of cases usually deal with very high recovery amounts.

If you’ve encountered fraudulent activity against the government in your job, contact an attorney whose practice focuses in this area of the law to discuss your situation. Consultations are free, without obligation and are strictly confidential. To contact an experienced attorney, please click here.

Case Studies: Amerigroup Corporation Settles Healthcare Fraud Case for $225M

Case Study 1: Profits Over Patients

Amerigroup Corporation, a healthcare company providing services to vulnerable populations, allegedly defrauded the Illinois Medicaid program by not enrolling eligible pregnant women and unhealthy patients in the state’s low-income program. The company’s actions were perceived as prioritizing profits over the well-being of patients. As a result, Amerigroup settled the case for $225 million, along with additional legal fees of nine million dollars.

Case Study 2: Corporate Integrity Agreement

In the settlement, Amerigroup did not admit any wrongdoing but agreed to enter into a corporate integrity agreement with the U.S. Health and Human Services Department. This agreement requires the company to follow a code of conduct to prevent discrimination in its enrollment and marketing practices in the future. It serves as a commitment to enhance transparency and accountability in healthcare operations.

Case Study 3: Whistleblower Rewards

An Amerigroup employee discovered the fraudulent activity and filed a whistleblower, or Qui Tam, lawsuit against the company on behalf of the government. The government joined the lawsuit, leading to a settlement. As the whistleblower, the employee will receive 25% of the settlement amount, totaling approximately $56 million. Whistleblower cases often result in significant rewards due to the high recovery amounts involved.