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Upcoding

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January 18, 2018

Detroit-area doctor Gerald Daneshvar was sentenced to 24 months in prison for his role in a $1.7 million health care fraud scheme that involved billing Medicare for physician home visits that were medically unnecessary and/or were billed under unwarranted treatment codes that resulted in inappropriately high payments. DOJ

June 30, 2017

Charlotte-Mecklenburg Hospital Authority (dba Carolinas Healthcare System) agreed to pay $6.5 million to resolve charges it violated the False Claims Act by “upcoding” claims for urine drug tests in order to receive higher payment than allowed for the tests.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Mark McGuire, a former laboratory director for CHS.  He will receive a whistleblower award of roughly $1.4 million from the proceeds of the government's recovery.  DOJ (WDNC)

June 26, 2017

AMI Monitoring Inc. (aka Spectocor), its owner Joseph Bogdan, Medi-Lynx Cardiac Monitoring LLC, and Medicalgorithmics SA, the current majority owner of Medi-Lynx, agreed to pay roughly $13.5 million to resolve allegations they violated the False Claims Act by billing Medicare for higher and more expensive levels of cardiac monitoring services than requested by the ordering physicians.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by former Spectocor sales manager Eben Steele.  He will receive a whistleblower award of roughly $2.4 million from the proceeds of the government's recovery.  DOJ

June 22, 2017

Dr. James M. Crumb, a physical medicine and rehabilitative specialist currently practicing in Alabama as Mobility Metabolism and Wellness, P.C.,and Coastal Neurological Institute, P.C., a local neurosurgeon physician group, agreed collectively to pay $1.4 million to resolve allegations they violated the False Claims Act by billing federal health care programs for medically unreasonable and unnecessary ultrasound guidance used with routine lab blood draws, and with Botox and trigger point injections. As a result of this billing scheme, the defendants sometimes billed 15 to 30 identical ultrasound guidance claims for a single patient office visit. DOJ (SDAL)

June 2, 2017

Fredericksburg Hospitalist Group, P.C. agreed to pay roughly $4.2 million to settle charges it violated the False Claims Act by upcoding evaluation and management (E&M) codes to the highest code levels in billing Medicare and other federal healthcare payors in connection with their providing hospitalist services to patients at Mary Washington Hospital and Stafford Hospital.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act.  The whistleblower will receive a yet-to-be-determined whistleblower award from the proceeds of the government's recovery. DOJ (EDVA)

February 6, 2017

U.S. hospital service provider TeamHealth Holdings (as successor in interest to IPC Healthcare Inc., f/k/a IPC The Hospitalists Inc.), agreed to pay $60 million to resolve allegations it violated the False Claims Act by billing Medicare, Medicaid, the Defense Health Agency and the Federal Employees Health Benefits Program for higher and more expensive levels of medical service than were actually performed (a practice known as “up-coding”).  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Dr. Bijan Oughatiyan, a physician formerly employed by IPC as a hospitalist.  He will receive a whistleblower award of roughly $11.4 million.  DOJ

United States Intervenes in Constantine Cannon Whistleblower’s suit against UnitedHealth Group, WellMed Medical Management

Posted  02/16/17
By the C|C Whistleblower Lawyer Team The U.S. Department of Justice has joined Constantine Cannon in bringing a whistleblower’s False Claims Act lawsuit against UnitedHealth Group, the nation’s largest health insurer and largest operator of Medicare managed healthcare insurance plans. The suit alleges UnitedHealth and its various subsidiaries and affiliates defrauded Medicare by improperly inflating its risk...

TeamHealth to Pay $60M to Settle Whistleblower Charges

Posted  02/7/17
By the C|C Whistleblower Lawyer Team U.S. hospital service provider TeamHealth Holdings agreed to pay $60 million to settle charges its predecessor company IPC Healthcare Inc. violated the False Claims Act by billing Medicare, Medicaid, the Defense Health Agency and the Federal Employees Health Benefits Program for higher and more expensive levels of medical service than were actually performed. See DOJ Press...
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