Last month, the Department of Justice announced that it was intervening in a False Claims Act case brought against IPC The Hospitalist Co. Inc., and its subsidiaries (IPC). This most recent case again illustrates the opportunities for corruption and abuse that exist within the health care community.
According to the DOJ, IPC is one of the largest providers of hospitalist service providers in America. It employs 1,400 doctors and nurses in over 1,300 facilities in 28 states.
Hospitalists are doctors who work only in hospitals and other long-term care facilities, such as nursing homes. They oversee and coordinate inpatient care at these various facilities.
The case was originally brought by Dr. Bijan Oughatiyan in 2009. In 2005, Dr. Oughatiyan was contacted by Medicare auditors regarding his irregular billing procedures. The auditors told the doctor that he was billing for too many costly medical procedures, and required him to attend a program on Medicare and Medicaid billing. It was after this program that Dr. Oughatiyan realized IPC was intentionally requiring its doctors to unlawfully charge for Medicare and Medicaid services.
According to Modernhealthcare.com, Dr. Oughatiyan alleged that IPC coached its doctors to systemically use higher-paying Medicare codes than were appropriate given the services provided. Dr. Oughatiyan stated that IPC closely monitored the billing practices of its employees and rewarded those who billed at the highest level for Medicare and Medicaid services. Known as “up-coding,” this practice is forbidden by the False Claims Act. IPC recently revealed to its shareholders that the government has requested information on its Medicare and Medicaid billing from January 2003 and June 4, 2010. If guilty, IPC will face steep fines and will likely be excluded from federal health programs.
Reducing Medical Fraud Through The False Claims Act
The False Claims Act is a powerful tool for combatting Medicare and Medicaid fraud. The False Claims Act permits individual citizens to bring lawsuits on behalf of the United States government against medical providers for fraudulent or unnecessary services. As in the case of Dr. Oughatiyan and IPC, the Act allows the DOJ to intervene and litigate the case. If successful, Dr. Oughatiyan will receive a portion of any judgment for his role as a whistle-blower. As reported by the DOJ, the Justice Department has recovered more than $17 billion through False Claims Act cases since 2009.
Fraudulent billing is just one example of potential abuse in nursing homes and health care facilities. Often, these unlawful billing practices are accompanied by accusations of resident mistreatment at the hands of providers. Elder mistreatment does not only mean physical abuse; a failure to provide adequate medical and living services can also amount to elder mistreatment.
As seen in the case of Dr. Oughatiyan and the IPC, it is often up to citizens to report Medicare and Medicaid fraud. Likewise, it is important to be aware of other signs of health care abuse such as nursing home abuse and neglect. If you or a loved one may potentially be a victim of fraud or abuse, it is imperative that you contact a lawyer. Our skilled attorneys have extensive experience in handling cases related to fraud, and nursing home abuse and neglect in Illinois. Contact us today to schedule your free consultation.
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