Molina Healthcare: Profiting from the Vulnerable

Molina and its subsidiary, Pathways of Massachusetts, settled for $4.6 million over allegations of violating the False Claims Act by billing Medicaid (MassHealth) for services provided by unlicensed and unsupervised staff.

The Massachusetts Attorney General found that Pathways billed for psychotherapy services rendered by unlicensed individuals. Molina knowingly submitted false certifications that violated licensure and supervision requirements. Four whistleblowers received a share of $810,000 from the settlement.

Molina failed to comply with state licensing laws, prioritizing profits over patient safety.

A whistleblower alleged Molina overbilled Illinois Medicaid by submitting fraudulent enrollment forms for nursing facility residents. The U.S. Supreme Court declined to dismiss the case in 2022, allowing it to proceed.

The lawsuit alleges that Molina knowingly submitted false claims for Medicaid reimbursements after its contract with GenMed ended in 2015. The Seventh Circuit revived the case in 2021 after it was initially dismissed by a lower court. The whistleblower claims Molina collected payments without providing services.

Molina's fraudulent billing practices defraud both the state and vulnerable nursing facility residents.

In June 2021, San Diego County sued Molina, HealthNet, and Kaiser Permanente for creating "ghost networks" with inaccurate provider directories, misleading consumers about access to care.

The lawsuit alleges that Molina falsely advertised provider availability, violating state and federal laws. Patients were unable to find in-network providers listed in directories, leading to delays or out-of-network costs. This practice disproportionately affected low-income and vulnerable populations.

Molina's deceptive provider directories denied patients access to necessary care, exacerbating healthcare disparities.

Washington's Insurance Commissioner fined Molina $100,000 in March 2024 for errors in its enrollment and billing system that caused confusion and coverage terminations for thousands of members.

Molina sent incorrect invoices to nearly 2,000 members and erroneously terminated coverage for at least 55 people. Pre-approved claims were denied due to processing errors, impacting access to care. The issues persisted even after transitioning to a third-party platform in April 2021.

Molina's persistent enrollment and billing errors disrupted coverage and access to essential healthcare services.

The Centers for Medicare & Medicaid Services (CMS) fined Molina $43,884 for noncompliance with Medicare Parts C and D regulations in early 2022. The violations included failing to meet requirements related to claims processing and beneficiary protections.

These violations impacted Medicare beneficiaries' access to timely care and medication coverage. The penalty reflects systemic issues with compliance across multiple states, highlighting Molina's ongoing struggles with regulatory adherence.

Molina's noncompliance with Medicare regulations hindered beneficiaries' access to essential healthcare services.

Louisiana accused Molina of facilitating overpayments to Medicaid pharmacy providers through its contractor, Unisys Corporation. Allegations surfaced in the mid-2010s, and the lawsuit remained ongoing as of late 2019.

The Louisiana Department of Health claimed that Molina's practices resulted in millions of dollars in overpayments. The state alleged that Molina failed to adequately oversee its contractor's billing practices, highlighting broader concerns about Molina's management of state Medicaid programs.

Molina's inadequate oversight led to significant financial losses for Louisiana Medicaid.

Molina was fined $58,500 in early 2016 for wage and hour violations involving its Michigan employees under state labor laws.

Employees were underpaid or denied overtime compensation. Violations included failure to comply with state minimum wage laws. This reflects broader labor issues within the company’s operations.

Molina's labor practices exploited employees, violating state wage laws.

Molina faced numerous fines for insurance violations across states like California, Texas, Washington, and New York between the mid-2010s and early 2020s.

Fines included $152,500 in California (2018) and $200,000 in Texas (2016). Violations ranged from improper claims handling to failure to meet regulatory standards. These repeated fines indicate systemic compliance issues within Molina.

Molina's recurring insurance violations reflect deep-rooted compliance failures.

Four former employees alleged retaliation after reporting fraudulent billing practices at Pathways clinics. This settlement was reached in June 2022 as part of a larger False Claims Act case involving Pathways clinics.

Employees received a portion of the settlement ($810,000) as compensation for retaliation claims. They reported being terminated or mistreated after raising concerns about unlicensed staff providing care. This case underscores issues with corporate culture at Molina subsidiaries.

Molina's hostile environment for whistleblowers allowed fraudulent practices to continue unchecked.

Molina sued Celgene (and parent Bristol Myers Squibb) under antitrust laws for monopolistic practices related to Thalomid and Revlimid drugs. The lawsuit was filed in California Superior Court and remains ongoing as of January 2022.

Molina alleged that Celgene used exclusive contracts and sham litigation to block generic competitors, inflating drug prices paid by Molina’s subsidiaries across multiple states. This lawsuit reflects broader concerns about rising drug costs impacting insurers and patients alike.

Molina's antitrust actions aim to dismantle monopolistic practices that drive up drug prices, burdening both insurers and patients.