TeamHealth Holdings, a major U.S. hospital service provider, has agreed to pay $60 million plus interest to settle a False Claims Act lawsuit filed by a physician who accused IPC Healthcare Inc., a hospital manager that TeamHealth acquired, of overcharging federally funded health care programs for the services it performed.
Dr. Bijan Oughatiyan, a physician formerly employed by IPC as a hospitalist, filed the original lawsuit under the whistleblower provisions of the False Claims Act, which allows private parties to sue on behalf of the federal government in cases of suspected fraud. Federal prosecutors investigated Dr. Oughatiyan’s claims and chose to back the case.
The government alleged that IPC ”knowingly and systematically” encouraged its hospitalists, medical professionals specializing in the care of hospitalized patients, to up-code their services on billing records, which meant billing the government for a higher level of services than were actually provided.
IPC’s scheme to maximize government billings in this way involved the company pressuring hospitalists with lower billing levels to “catch up” to their peers, the lawsuit contended.
According to the whistleblower complaint, IPC submitted these false claims to Medicare, Medicaid, the Defense Health Agency, and the Federal Employees Health Benefits Program.
“False documentation of treatment is not just flawed patient care; it is illegal,” said U.S. Attorney Zachary T. Fardon for the Northern District of Illinois, who helped prosecute the case.
Lamont Pugh, Special Agent for the Department of Health and Human Services’ Office of Inspector General added that his agency was committed to chasing down those who commit health care fraud. “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,” he said.
Whistleblowers whose False Claims Act lawsuits lead to a financial recovery receive up to percent of the total amount recovered as an award for their role in exposing the fraud. Whistleblower awards can be as high as 30 percent in False Claim Act cases in which the U.S. Justice Department declines to intervene. Mr. Oughatiyan will receive about $11.4 million (19 percent of the recovery) for blowing the whistle on ITC.
Source: U.S. Department of Justice