TeamHealth Holdings, a hospital service provider, recently agreed to pay out $60 million plus interest to settle claims that one of its subsidiaries, IPC Healthcare Inc., knowingly overcharged certain federal healthcare programs.
According to the U.S. Department of Justice, IPC Healthcare violated the False Claims Act by overbilling Medicaid, Medicare, the Federal Employees Health Benefits Program and the Defense Health Agency for more expensive services than those actually performed. This is a process known as “upcoding,” one of the more common FCA violations. IPC was acquired by TeamHealth in 2015 for $1.6 billion, meaning the sanctions are now the holding company’s responsibility.
In the prolonged fraudulent scheme, IPC allegedly encouraged workers to bill at the highest levels possible. The company was also alleged to have pressured workers who had lower billing levels to “catch up” to their coworkers by billing at the higher levels. Hospitalists also routinely submitted billing records each day for services that would have taken more than 24 hours to perform by any reasonably conservative estimate.
The lawsuit was filed by Dr. Bijan Oughatiyan, who worked for IPC from 2003 to 2008. He said IPC trained its hospitalists to overbill, and that the practice was encouraged in the workplace. For his role in uncovering the fraud and reporting it to the federal government, Dr. Oughatiyan will receive $11.4 million of the $60 million recovery.
TeamHealth was also required to enter into a five-year corporate integrity agreement with the Office of Inspector General in the Department of Health and Human Services. The company will be ordered to increase accountability and transparency to ensure future fraud or abuse does not occur.
There are many benefits for whistleblowers who would come forward and share information with federal agencies about corporate wrongdoing. The SEC Office of the Whistleblower alone has rewarded whistleblowers with nearly $140 million since its inception. To learn more about your options, consult a trusted Dallas attorney at Whistleblower Law for Managers.