Behavioral Health Network Issues Lead to $4.6M Fine for Molina

Meeting Medicaid network adequacy requirements for behavioral health providers continues to be a challenge for health insurers, as shown by a recent $4.6 million settlement between Molina Healthcare, Inc., its former behavioral health subsidiary, Pathways of Massachusetts, and the Department of Justice. 

In the case, Molina and Pathways of Massachusetts agreed to pay $4.625 million to resolve False Claims Act allegations that they submitted claims to MassHealth — the state’s Medicaid program — while violating regulations governing how staff are licensed and supervised, the U.S. Attorney’s Office for the District of Massachusetts said on June 21. The settlement in the case, which was first brought by four whistleblowers who were Pathways employees, calls for the former employees to receive $810,000.