A group of 88 Urgent Care centers throughout New York agreed to settle a claim with the government for over $6 million dollars.
What were the accusations against the medical services provider? The government’s claim involved allegations the medical facility violated the False Claims Act. These violations were allegedly the result of filing claims for payment from Medicare for “more expensive and complex services than were actually provided to patients,” according to the Department of Justice (DOJ).
The DOJ had gathered evidence to support the allegations. Some of the evidence used in the case included:
- Record keeping. The government contended the records kept by the facilities was insufficient to support the claims. These records did not include enough detail to support the more complex procedures the center allegedly provided and requested coverage for within their billing requests to Medicare.
- Credentialing issues. The government also states that the medical facility failed to follow proper protocol for the physicians providing the services. Essentially, the DOJ states that these physicians did not always have the proper credentialing required to receive payment from Medicare.
- Billing issues. The facility was also accused of intentionally using credentialed physician’s National Provider Identification numbers on services provided by uncredentialled physicians within Medicare billing requests.
This and other evidence gathered during the investigation was sufficient to encourage settlement negotiations. This serves as a reminder that any medical facility that finds itself subject to an investigation should act promptly to begin building a defense to any potential allegations of wrongdoing.
What led to these allegations? It appears this case began with a report from a whistleblower, potentially from within the medical facility.
What was the final settlement agreement? A United States District Judge approved a settlement negotiated between the government and the medical centers. The agreement requires the facilities to admit wrongdoing and accept responsibility. This comes with a restitution payment of $6,606,251.40.