State Settles with Sioux Falls Doctor in Civil Case Involving Medicaid Payments

  
State Settles with Sioux Falls Doctor in Civil Case Involving Medicaid Payments

 

FOR IMMEDIATE RELEASE :  Tuesday, January 29, 2013
CONTACT:  Sara Rabern (605)773-3215  

 

 
State Settles with Sioux Falls Doctor in Civil Case Involving Medicaid Payments


 
PIERRE, S.D.-    South Dakota Attorney General Marty Jackley announced today that the State of South Dakota has reached a settlement with Annette M. Bosworth, MD, in a civil case involving Medicaid payments. 

The State contends that Bosworth submitted claims for reimbursement to Medicaid which contained partially inaccurate information. Specifically, that Bosworth submitted claims for services that may have been provided with the assistance of a physician assistant without an approved supervision agreement to practice. The Board and Bosworth settled this matter on June 27, 2012. In addition, that Bosworth submitted claims to Medicaid for non-covered services. Specifically, Bosworth provided treatments involving Venofer to patients who were under the age of 19, and DSS considers such services as non-covered services. Bosworth failed to indicate in the patients’ records that oral iron therapy was rejected before administering Venofer.

 The settlement is neither an admission of wrongdoing or liability by Bosworth, nor a concession by South Dakota that its claims are not well founded.

Pursuant to the settlement, Bosworth has agreed to pay $14,790.32 to South Dakota. The State will offset that amount by the total of amount of eligible suspended Medicaid claims ($9,260.98). Thus, Bosworth agreed to pay the net amount of $5,529.34. Federal regulations require states to suspend Medicaid payments to providers during the pendency of overpayment cases.

The Medicaid program will be fully reimbursed for the covered claims.

“As with any Medicaid payment issue, we work with the provider to resolve the matter without litigation when possible. In this case, we were able to ensure that Medicaid funds were properly utilized, while treating the provider fairly,” said Jackley.

The case was handled by the South Dakota Attorney General’s Medicaid Fraud Control Unit, with assistance from the federal Department of Health and Human Services - Office of Inspector General, and the South Dakota Department of Social Services.


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