Agency Settles Fraud Suit For $60 Million
According to the Chicago Daily Law Bulletin a hospital-staffing corporation will pay $60 million to resolve allegations it submitted fraudulent bills to Medicare, Medicaid and other government health-care programs, the U.S. Justice Department announced Monday.
Dr. Bijan Oughatiyan, who blew the whistle on IPC Healthcare Inc.’s purported wrongdoing, will receive about $11.4 million of the recovery.
IPC, a company based in North Hollywood, Calif., provides physicians to work in hospitals.
IPC employs about 2,500 of these physicians, called hospitalists, in Illinois and 27 other states.
Oughatiyan worked for IPC from 2003 to November 2008.
In a lawsuit filed in federal court in Chicago in 2009, he accused IPC of violating the False Claims Act by “upcoding,” or billing for higher and more expensive levels of medical services than it actually provided.
In addition to Medicaid and Medicare, he maintained, programs that paid fraudulent billings included the Defense Health Agency and the Federal Employees Health Benefits Program
Oughatiyan filed the suit under the qui tam, or whistleblower, provisions of the act.
The federal government intervened in the case in 2013.
In 2015, Team Health Holdings Inc. of Knoxville, Tenn., acquired IPC.
TeamHealth, in turn, was acquired on Monday by The Blackstone Group L.P., a New York-based investment firm.
TeamHealth did not acknowledge any wrongdoing by agreeing to the settlement.
The lead attorney for Oughatiyan, Matthew K. Organ of Goldberg Kohn Ltd., said he’s pleased with the settlement.
“We’re very proud of our client who had the unique courage to come forward and report fraud, which can be a challenging thing to do,” Organ said.
“On another front, we’re very grateful for the opportunity to partner with the government in litigating this case against IPC.”
Oughatiyan, an internist, now practices medicine outside of Dallas.
The federal government was represented by attorneys who included Elizabeth Rinaldo of the Justice Department in Washington, D.C.
Also representing the government were Assistant U.S. Attorney Eric S. Pruitt and David R. Lidow, a former federal prosecutor who is now with the U.S. Merit Systems Protection Board.
“Medical providers who fraudulently seek payments to which they are not entitled will be held accountable,” U.S. Attorney Zachary T. Fardon said in a statement.
“False documentation of treatment is not just flawed patient care; it is illegal.”
TeamHealth was represented by attorneys who included Tinos Diamantatos of the Chicago office of Morgan Lewis Bockius LLP.
Also representing TeamHealth were Scott A. Memmott and Holly C. Barker, both of the law firm’s Washington office.
As part of the settlement, TeamHealth entered into a five-year corporate integrity agreement with the U.S. Department of Health and Human Services Office of Inspector General.
The agreement, which covers TeamHealth’s hospital medicine division, is designed to increase the company’s accountability.
“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 Lamont Pugh, the office’s special agent in charge.
The case is United States ex rel. Oughatiyan v. IPC The Hospitalist Inc., et al., No. 09 C 5418.