Team Health Holdings, Inc., a physician staffing firm, will have to face a False Claims Act lawsuit alleging the company overbilled Medicaid and Medicare for services not performed. This is due to a decision by a Texas federal judge who is allowing the case to proceed, saying the two whistleblowers who brought forth the claim provided sufficient evidence to allow it to proceed.
Team Health had attempt to dismiss the complaint, which was amended from a previous form in which the whistleblowers did not provide substantial enough evidence to allow it to proceed.
In the claim, the whistleblowers Caleb Hernandez and Jason Whaley describe the processes used by the privately owned company to bill for services performed by nonphysician healthcare providers as if they were delivered by actual doctors. Services performed by nonphysicians are only reimbursed at 85 percent of the rate as services performed by physicians, so Team Health was able to boost its reimbursement substantially over time due to this fraudulent practice.
The whistleblowers also provided evidence about when services were rendered, which employees at Team Health were involved, when the alleged fraudulent billing occurred and how the scheme was perpetrated. Their earlier complaint did not include specific information about which clinicians, hospitals and practice groups were involved, described an overly broad time range and did not specify the exact location of the scheme, which is why judges requested the whistleblowers modify it for resubmission.
Team Health has had other litigation surrounding its billing practices in recent years, including a case that resulted in a $60 million FCA settlement in 2017.
For more information about the steps you should take if you become aware of fraudulent behavior within your company or organization, contact an experienced whistleblower attorney at Kardell Law Group.