Fredericksburg Hospitalist Group, P.C. (FHG), and 14 of its member shareholders have agreed to pay approximately $4.2 million to settle a federal False Claims Act (FCA) case brought under the qui tam whistleblower provisions of the FCA.
“Rooting out fraudulent billing by healthcare providers is a priority,” said Dana J. Boente, U.S. Attorney for the Eastern District of Virginia. “This office will continue to pursue such matters vigorously.”
The whistleblower complaint, which was originally filed under seal, alleged that FHG and its member hospitalists knowingly and intentionally upcoded evaluation and management (E&M) codes to the highest code levels in billing Medicare and other federal healthcare payors in connection with their providing hospitalist services to patients at Mary Washington Hospital and Stafford Hospital. After an investigation into the matter, the United States alleged that from January 2010 through April 2015, the defendants knowingly and intentionally increased the level of E&M codes to the highest code levels, resulting in increased reimbursement amounts paid by the federal healthcare payors to the billing defendants.
“Whether it’s upcoding, billing for undelivered services, or delivery of substandard care, our nationally renowned Medicaid Fraud Control Unit will never stop working to root out fraud, waste, and abuse that steals from taxpayers and weakens these important programs for Virginians who need these services,” said Mark Herring, Virginia Attorney General.
The whistleblower, also known as a “relator,” alleged that the defendants’ conduct violated the FCA. In such cases, the United States has an opportunity to investigate the claims. Under the FCA relators may be awarded up to 25 percent, or more, of amounts collected.
The resolution obtained in this matter was the result of a coordinated effort between the U.S. Attorney’s Office for the Eastern District of Virginia, the Virginia Medicaid Fraud Control Unit within the Office of the Virginia Attorney General, the Department of Health and Human Services, Office of Inspector General, the Defense Criminal Investigative Service, and the U.S. Office of Personnel Management, Office of the Inspector General.
The matter was investigated by Assistant U.S. Attorney Robert McIntosh, and Assistant Attorney Generals Vincent J. Vaccarella and Adele M. Neiburg. The civil claims settled by this FCA agreement are allegations only; there has been no determination of civil liability.