Physician Awarded $11.4 Million for Reporting Illegal Billing Scheme

TeamHealth Holdings, a U.S. hospital service agreed to resolve allegations that its violated the False Claims Act by billing Medicare, Medicaid, the Defense Health Agency and the Federal Employees Health Benefits Program for more expensive levels of medical service than were performed (a practice known as “up-coding”). TeamHealth agreed to pay $60 million, plus interest to settle the case, according to a February 6, 2017 announcement by the Department of Justice.

The government contended that TeamHealth’s predecessor, IPC Healthcare Inc., f/k/a IPC The Hospitalists Inc. (IPC) knowingly and systematically encouraged false billings by its hospitalists, who are medical professionals whose primary focus is the medical care of hospitalized patients. Specifically, the government alleged that IPC encouraged these medical professionals to bill for a higher level of service than was provided. IPC’s scheme to improperly maximize billings allegedly included corporate pressure on those medical professionals with lower billing levels to “catch up” to their peers.

A physician formerly employed by IPC, Dr. Bijan Oughatiyan, filed a lawsuit under the qui tam, or whistleblower, provisions of the False Claims Act. These provisions permit private individuals to sue on behalf of the government for false claims and to share in any recovery. The Act also allows the government to intervene and take over the action, as it did in this case. Mr. Oughatiyan will receive approximately $11.4 million for his assistance in this case.

Links:

• DOJ Press Release – Healthcare Service Provider to Pay $60 Million to Settle Medicare and Medicaid False Claims Act Allegations
• Medicare & Medicaid Fraud Resources