January 14, 2014 — What can health care insiders do to prevent Medicare from being deluged with false claims from hospitals and other health care providers? The reality is that the U.S. Justice Department (DOJ) counts on information from health care tipsters to fight fraud. The False Claims Act includes qui tam provisions giving informants the power to file a lawsuit for the benefit of the government. To encourage whistleblowers to do the right thing, the Act entitles tipsters to a handsome cut of the recovery.
California Hospitalist Provider Overbilled Federal Healthcare Programs for Physician Services
The government has intervened in a whistleblower lawsuit filed in federal court in Chicago against IPC The Hospitalist Co. Inc., and its subsidiaries (IPC). The False Claims Act suit alleges that IPC, based in North Hollywood, California, made false claims to various federal healthcare programs. Employing doctors and other health care providers in over 1300 treatment facilities in 28 states, IPC is one of the largest hospitalist providers in the nation. A hospitalist is a doctor who works solely in hospitals and long-term care facilities, taking charge of inpatient care from the time of a patient’s admission up to the point of discharge.
According to the DOJ, IPC physicians engaged in upcoding when submitting claims to the government. Upcoding is the practice of seeking reimbursement for more expensive levels of medical care than were actually provided. IPC allegedly encouraged its doctors to bill for services at the highest levels, without regard to the level of service provided and trained its doctors how to use the higher code levels. Providers with lower billing levels were allegedly admonished to “catch up” to their counterparts.
The qui tam lawsuit was brought by Dr. Bijan Oughatiyan, formerly an IPC physician. If the government makes a successful recovery in the case, Dr. Oughatiyan will share a portion of the proceeds.
Blowing the Whistle on Medicare Billing Fraud
Most health care insiders want to steer clear of Medicare fraud operations. These hardworking employees should understand their full rights as laid out in the False Claims Act before they bring a claim. With experienced whistleblower lawyers in Texas, California and the Washington, D.C. area, Waters & Kraus is devoted to protecting your interests. When you’re committed to collaborating with the government, contact us or phone our False Claims Act lawyers at 855.784.0268 to discuss our qui tam practice.
