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Molina Healthcare headquarters in Long Beach, California Photo: Jeff Gritchen/Digital First Media/Orange County Register via Getty Images

A newly unsealed lawsuit accuses Molina Healthcare of cutting corners in its mental health services for children and defrauding Medicaid in the process.

The big picture: Molina provides Medicaid managed-care plans in more than a dozen states. The whistleblower suit accuses the company of overbilling specifically for children's behavioral health services, to the tune of at least $20 million across multiple federal, state and local agencies.

Details: The lawsuit, which was filed in 2018 but under seal until last month, claims that Molina and two of its subsidiaries failed to maintain individualized treatment plans for some of the children it covered, as required by law. 

  • The company billed some care as if it had been supervised by a professional, even when it wasn't, the lawsuit says, and didn't give some of its providers the proper training.
  • The suit also alleges that Molina provided care for kids who weren't eligible, either because their conditions were too severe for this kind of counseling to make a difference or because their family members couldn't or wouldn't take part in Molina's therapy sessions.
  • And it says Molina illegally fired an employee who complained about those practices.

The other side: Spokespeople from Molina did not respond to a request for comment on the suit.

Go deeper

Aug 14, 2020 - Health

The kids who are most at risk from the coronavirus

Illustration: Eniola Odetunde/Axios

The coronavirus isn't as deadly for children as it is for adults, but kids still get it and can still get seriously sick from it. The risk is higher for Black and Hispanic children.

Why it matters: In communities with high caseloads, cases among children could explode as schools reopen. And kids in the communities already hit hardest by the pandemic are the most at risk.

Felix Salmon, author of Capital
7 mins ago - Economy & Business

How the pandemic caused a corporate rebound

Illustration: Sarah Grillo/Axios

WeWork becomes a public company today worth more than $9 billion — a vindication of the expensive turnaround strategy employed after it spectacularly imploded in 2019. Like many companies that find themselves at death's door, that which didn't kill them made them stronger.

Why it matters: Hertz, Alamo Drafthouse, Airbnb, and Toast are among the currently-thriving companies that were shaken to the core in the early days of the pandemic — providing further evidence for the theory that, in the words of former Fast Company editor Bill Taylor, "companies can't be great unless they've almost failed."

37 mins ago - Health

Aduhelm is bombing

The average list price of Aduhelm is roughly $4,300 per monthly infusion. Photo: Biogen

Biogen sold $300,000 worth of Aduhelm in the third quarter, well below Wall Street's expectations, which prompted analysts at Raymond James to call the Alzheimer's drug "potentially the worst drug launch of all time" amid Biogen's "persistent hyperbole about the drug's purported benefits."

The big picture: Aduhelm's controversial approval and high price tag have shaped the market reaction. Health insurers are hesitant to cover Aduhelm until Medicare makes a decision next year, and doctors aren't embracing the drug either.

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