Recently, the Department of Justice announced that TeamHealth Holdings (successor in interest to IPC Healthcare Inc.) has agreed to pay $60 million to resolve upcoding allegations 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. The government contended that the defendant knowingly and systematically encouraged false billings by its ‘hospitalists’ (medical professionals whose primary focus is the medical care of hospitalized patients). The allegations centered on the defendant encouraging its hospitalists to bill for a higher level of service than actually provided which included corporate pressure on hospitalists with lower billing levels to “catch up” to their peers.
“Medical providers who fraudulently seek payments to which they are not entitled will be held accountable,” said U.S. Attorney Zachary T. Fardon for the Northern District of Illinois. “False documentation of treatment is not just flawed patient care; it is illegal.”
“When health care companies boost their profits by misrepresenting the services they bill to taxpayer-funded health care programs, our office will make sure they are held accountable for their deceptive schemes and that they make changes to bill these programs appropriately,” said Special Agent in Charge Lamont Pugh of HHS-OIG.
Dr. Bijan Oughatiyan, a formerly employed by IPC as a hospitalist was the physician whistleblower in this False Claims Act case and will be receiving an approximate $11.4 million whistleblower reward.
More information for potential healthcare whistleblowers is located at Nolan Auerbach & White’s main website.