(The Center Square) – An urgent care network has agreed to repay more than $9 million to the federal government to settle allegations of submitting false claims for COVID-19 testing and other medical services.
Sayler Fleming, U.S. attorney in the Eastern District of Missouri, announced the $9,105,794 settlement on Thursday. Her office alleged Total Access Urgent Care practiced upcoding – submitting claims to government or private insurance companies with codes indicating more serious diagnoses or procedures to gain higher amounts of reimbursement – for several years.
“This settlement will fully repay three federal health care programs for TAUC’s overbilling for COVID tests and office visits,” Fleming said in a statement.
The company submitted claims for payment to Medicare and TRICARE, the health care program for active duty service members, from April 2017 to November 2021, according to a media release from Fleming’s office. The allegations include a non-physician practitioner performing office visits but the insurance claims stating a physician performed the service, which gained a larger government reimbursement.
The office alleged the company upcoded claims to the federal government’s COVID-19 program for the uninsured. During the pandemic, the attorney stated claims were submitted for reimbursement for testing, treatment and vaccination against COVID-19 for people who were uninsured.
During the investigation, the company voluntarily disclosed it submitted false claims to three government insurance programs from April 1, 2021, through Dec. 31, 2021, to get higher reimbursements. The settlement also covered the company’s self-disclosure to the Centers for Medicare and Medicaid Services in March 2021 of bonuses paid to certain physicians based, in part, on the volume or value of referrals for specific health services.
The company fully cooperated during the investigation, but didn’t admit liability in the settlement, according to the media release.
“Today’s outcome illustrates the Health and Human Services Office of Inspector General’s unwavering commitment to detecting, investigating and shutting down fraud against Medicare, the HRSA (Health Resources and Services Administration) Uninsured Program and protecting federal health care programs under any circumstance – especially during a public health emergency,” Acting Special Agent Curt L. Muller of the U.S. Department of Health and Human Services Office of Inspector General said in a statement. “Our agency, working with our law enforcement partners, will continue to investigate health care fraud schemes, including those involving providers submitting fraudulent claims in violation of the False Claims Act.”
The office stated all false claims resulted in the company receiving reimbursement it wasn’t entitled to from federal health care programs.
“When actors within our healthcare system are focused on profit rather than patient care, it undermines the integrity of the medical decision-making process,” Gregory P. Shilling, acting special agent-in-charge of the Department of Defense Office of Inspector General’s Defense Criminal Investigative Service, said in a statement. “(Our office) remains steadfastly committed to rooting out fraud and safeguarding the funds entrusted to the Defense Health Agency, which serves our military members and their families.”
