Government Intervenes in False Claims Lawsuit Against Ipc the Hospitalist Co. Inc. Alleging Overbilling of Physician Services

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Monday, December 9, 2013

Government Intervenes in False Claims Lawsuit Against Ipc the Hospitalist Co. Inc. Alleging Overbilling of Physician Services

The government has intervened in a lawsuit against IPC The Hospitalist Co. Inc., and its subsidiaries (IPC), alleging that IPC submitted false claims to federal health care programs, the Justice Department announced today.  IPC, based in North Hollywood, Calif., is one of the largest providers of hospitalist services in the United States, employing physicians and other health care providers who work in more than 1,300 facilities in 28 states.  Hospitalists are physicians who work only in hospitals and other long-term care facilities, overseeing and coordinating inpatient care from admission to discharge.
The lawsuit alleges that IPC physicians sought payment for higher and more expensive levels of medical service than were actually performed – a practice commonly referred to as “upcoding.”  Specifically, the lawsuit alleges that IPC encouraged its physicians to bill at the highest levels regardless of the level of service provided, trained physicians to use higher level codes and encouraged physicians with lower billing levels to “catch up” to their peers.
“We continue to be vigilant in our enforcement efforts to ensure that health care programs funded by the taxpayers pay only for appropriate costs,” said Assistant Attorney General for the Justice Department’s Civil Division Stuart F. Delery.
The lawsuit was filed by Dr. Bijan Oughatiyan, a former IPC physician, under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties to sue for false claims on behalf of the government and to share in any recovery.  The Act also allows the government to intervene or take over the lawsuit, as it has done in this case, and to recover three times its damages plus civil penalties.  The government has asked the U.S. District Court in Chicago for 120 days to file its own complaint stating its allegations.

http://www.justice.gov/opa/pr/2013/December/13-civ-1294.html

Yakima Doctor convicted of Medicare fraud to forfeit $129K

YAKIMA, Wash. — A sentencing hearing has again been postponed in the case of Dr. Curtis Holden, who late last year was convicted of Medicare and Medicaid fraud. However, under a recent settlement, Holden agreed to pay $129,000, far less than what a jury found he stole from the U.S. government.

Holden, formerly of Advanced Podiatry Specialists of Yakima, was convicted in early December on 32 counts of health care fraud for routinely “upcoding” patient visits billed to Medicare and Medicaid, effectively changing patient records to exaggerate what services he had performed in order to get higher reimbursement from the government.

Prosecutors in the case said his fraudulent billing practices lasted for several years in the 2000s, though the counts on which he was found guilty are from 2006 and 2007.

In the forfeiture document, filed Friday, Holden agreed to turn over his 2004 BMW X5 along with $129,675.84 seized by the FBI from various bank accounts.

The document also noted that Medicare is still holding $54,157.32 in payments that Holden had billed but the government suspended when it discovered he had misrepresented the services billed.

The forfeited funds will go directly toward restitution to the government health plans. The document says that figure “settles all criminal and civil claims” filed last June and “the Complaint for Violations of Federal False Claims Act” filed in June 2010.

The government previously contended that Holden owes Medicare and Medicaid about $630,000 more than the settlement amount. But the defendant disputed the sum, and at a hearing on the matter, “the amount was compromised,” according to court documents.

Assistant U.S. attorney Joe Harrington said the settlement was determined to be appropriate by both parties, and that the decision to accept the figure was made by U.S. attorneys after consulting with Medicare. Part of the reason for settling was the “litigation risk” attorneys would carry if they tried to further pursue the full amount in court.

“We have an adversarial criminal justice system; there’s two sides to every story ... There’s always litigation risk that your position wouldn’t be accepted by the court,” Harrington said.

The court has scheduled Holden’s sentencing hearing for Oct. 22. It was originally scheduled for July 9, then was pushed back by a postponement of the forfeiture hearing, which was canceled this week as the two parties came to an agreement on forfeiture motions.

It’s possible Holden could receive a prison sentence, but Harrington said it would be impossible to speculate on that likelihood.

http://www.yakimaherald.com/news/yhr/wednesday/1447494-8/yakima-doctor-convicted-of-medicare-fraud-to-forfeit