A Georgia urgent care center has agreed to pay $1.6 million to end a lawsuit that accuses them of violating the False Claims Act after the defendants submitted Medicare claims that were improperly coded according to the U.S. Attorney's Office for the Northern District of Georgia.
In a release issued by the attorney's office of the Northern District of Georgia, the defendants “improperly upcoded Evaluation and Management claims to Medicare for the testing and treatment of patients with suspected exposure to COVID-19 during the Coronavirus pandemic.” In doing so, the defendants misrepresented the services that were actually being offered.
"When providers submit improper claims to Medicare, they waste valuable taxpayer dollars," Special Agent in Charge with the Department of Health and Human Services, Office of Inspector General Tamala Miles shared in the release.
U.S. Attorney Ryan K. Buchanan added, “But medical practices that seek to misrepresent the services they provide to patients, and to improperly profit from such practices, must be held accountable.”
The Atlanta-based groups CRH Healthcare, LLC and Peachtree Immediate Care FP, LLC were under the investigation of the U.S. Department of Health and Human Services, Office of Inspector General, and the Federal Bureau of Investigation. The investigation was prompted after a former employee of CRH Healthcare filed a civil lawsuit in the U.S. District Court for the Northern District of Georgia under the whistleblower provisions of the False Claims Act.
Under this act, private citizens are allowed to bring forward lawsuits against companies that engage in false claims on behalf of the United States. In bringing forward a lawsuit, whistleblowers can share in any recovery the government collects.
The False Claims Act aims to protect government entities and taxpayers alike by levying fines including treble damages (measured at three times the losses caused by the false claim). Civil penalties can range anywhere between $13,508 to $27,018 per false claim.
In this case, the whistleblower will be awarded $320,000 out of the $1.6 million judgment levied against the defendants.
"Healthcare providers played a critical role in keeping our nation safe during the COVID-19 pandemic, and HHS-OIG is committed to protecting federal healthcare programs from fraud, waste, and abuse to ensure they can be used for their intended purposes," Ms. Miles shared.
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