South Raleigh News

Attorney General Josh Stein announced a $2.45 million settlement with Vista Clinical Diagnostics, LLC, for allegedly submitting or causing the submission of false claims to Medicare and Medicaid programs in North Carolina, Virginia, and Florida. The settlement funds will be returned to the Medicare and Medicaid programs.

"Health care providers must be responsible stewards of taxpayers’ hard-earned money," said Attorney General Josh Stein. "I’m pleased that this money will go back to the taxpayers and be used to pay for people’s much-needed health care. My office will not allow people to defraud our Medicaid program."

From January 1, 2017, through December 31, 2021, Vista Clinical allegedly submitted or caused to be submitted reimbursement claims to Medicare and Medicaid by adding diagnosis codes into patients’ reimbursement submissions that had not been provided by those patients’ physicians.

It should be noted that the civil claims resolved by settlement here are allegations only, there has been no judicial determination or admission of liability, and Vista Clinical and its related pass-through entities deny the allegations.

This settlement results from a whistleblower lawsuit. The investigation and prosecution of this case were conducted by the United States Attorney’s Office for the Middle District of Florida, the Office of Inspector General of the United States Department of Health and Human Services, the Medicaid Investigations Division (MID) of the North Carolina Attorney General’s Office, the Florida Office of the Attorney General, the Office of the Virginia Attorney General’s Medicaid Fraud Control Unit, and the Virginia Department of Medical Assistance Services.

The MID investigates and prosecutes health care providers that defraud the Medicaid program, patient abuse of Medicaid recipients, patient abuse in facilities receiving Medicaid funding, and misappropriation of any patients’ private funds in nursing homes receiving Medicaid funding. To date, MID has recovered more than $1 billion in restitution and penalties for North Carolina.

To report Medicaid fraud or patient abuse in North Carolina, call MID at 919-881-2320. MID receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $8,535,748 for Federal fiscal year (FY) 2023. The remaining 25 percent is funded by North Carolina.