A settlement has been reached to resolve False Claims Act allegations against TeamHealth Holdings.
The allegations arose from a lawsuit that claimed TeamHealth Holdings, as successor in interest to IPC Healthcare Inc (IPC) violated the False Claims Act by billing Medicare, Medicaid, the Defense Health Agency and the Federal Employees Health Benefits Program for higher and more expensive levels of medical service than were actually performed.
According to the Department of Justice, the government contended that allegedly IPC knowingly and systematically encouraged false billings by its hospitalists, who are medical professionals whose primary focus is the medical care of hospitalized patients. Particularly, the government alleged that IPC encouraged its hospitalists to bill for a higher level of service than actually provided. IPC’s scheme to improperly maximize billings allegedly included corporate pressure on hospitalists with lower billing levels to “catch up” to their peers.
Reportley, TeamHealth, as part of the settlement, entered into a five-year Corporate Integrity Agreement (CIA) with the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) covering the company’s hospital medicine division. This CIA is designed to increase TeamHealth’s accountability and transparency so that the company will avoid or promptly detect future fraud and abuse.
“When health care companies boost their profits by misrepresenting the services they bill to taxpayer-funded health care programs, our office will make sure they are held accountable for their deceptive schemes and that they make changes to bill these programs appropriately,” said Special Agent in Charge Lamont Pugh of HHS-OIG.
The whistleblower, Dr. Bijan Oughatiyan, a physician formerly employed by IPC as a hospitalist, will receive approximately $11.4 million from the settlement.
