Qui Tam Lawsuit Involving Healthcare Fraud Intervened by US Government

United States intervenes in a qui tam lawsuit alleging that IPC the Hospitalist Company, Inc., committed healthcare fraud by up-coding physicians’ services and defrauding Medicare and Medicaid.

NEW YORK, New York, December 31, 2013 – On December 9, 2013, the Department of Justice announced that it had intervened in a False Claims Act lawsuit1 against IPC the Hospitalist Company, Inc., a California-based company and one of the largest providers of hospitalist services in the United States. The qui tam lawsuit alleges that IPC violated state and federal False Claims Acts by “knowingly engaging in systematic overbilling for hospital evaluation and management services billed to Medicare, Medicaid, and other federal health benefit programs.”

In particular, the lawsuit alleges that IPC pushed its physicians into billing at the highest and most expensive levels regardless of the actual service that was provided. This illegal practice is known as “upcoding” and it is done at doctors’ offices, hospitals, and other healthcare facilities across the country in order to illegally maximize the amount of reimbursement the facility will receive from Medicaid or Medicare. The lawsuit against IPC alleges that the government overpaid millions of dollars as a result of hospitalist upcoding.

Hospitalists are physicians who work exclusively for hospitals and other long-term care facilities. They provide day-to-day patient oversight and coordinate patient care from admission through discharge. The lawsuit alleges that not only did IPC encourage its hospitalists to up-code but that the company was well-aware of the practice and knew or should have known that its hospitalists could not have actually been performing the billed services at the levels for which claims were submitted to the government for reimbursement.

According to the DOJ, the lawsuit was filed under seal in 2009 by a doctor who worked as a hospitalist for IPC for five years. Under the qui tam provisions of the False Claims Act, a relator or whistleblower with credible information regarding fraud can bring a claim on behalf of the state and federal government to recover funds which were wrongfully paid out due to fraud. A False Claims Act case is filed under seal to allow the government time to investigate the case and determine whether it will “intervene” or take over the action. If the case is successful, the government could recover millions of dollars and the hospitalist-whistleblower will be entitled to 15-30% of the recovery for his efforts.

Anyone who has information about upcoding which results in overbilling a government healthcare program, can help the government recover funds and receive up to 30% of the recovery, by becoming a whistleblower. The national whistleblower attorneys at Levy Konigsberg LLP handle Medicare and Medicaid Fraud cases nationwide. The firm offers a free and confidential consultation, which can be requested by calling their 24/7 hotline at 1-888-372-8387 or 1-212-605-6200, or by submitting an email inquiry (see form above).

1 http://www.justice.gov/usao/iln/pr/chicago/2013/pr1209_01.html

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