$10M Scam: Nextcare Inc. Faked Urgent Care Bills

[Image: Nextcare Inc. logo]

Nextcare Inc., an Arizona-based company, has agreed to pay $10 million to settle federal and state allegations that it submitted false claims, the Justice Department announced today.

The settlement resolves allegations that Nextcare submitted false claims to Medicare, TRICARE and the Federal Employees Health Benefits Program, as well as the Medicaid programs of Colorado, Virginia, Texas, North Carolina and Arizona, by billing for unnecessary allergy, H1N1 virus and respiratory panel testing.

The United States also alleged that Nextcare inflated billings for urgent care medical services in the years under review, a practice known as upcoding.

"This settlement demonstrates the Justice Department’s commitment to ensuring that federal health care dollars are spent appropriately," said Stuart Delery, Acting Assistant Attorney General for the Civil Division.

Former Nextcare employee Lorin Cohen initially raised the allegations in a lawsuit filed against the company.

Cohen will receive $1.614 million as her share of the recovery, which is part of the government’s emphasis on combating health care fraud and another step forward for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative.

This resolution is also a reminder that providers who subject beneficiaries to unnecessary medical testing, as alleged against Nextcare, compromise the well-being of their patients and squander Federal health care funds.

Nextcare Inc. is also required to enter into a Corporate Integrity Agreement with HHS-OIG under which the company will be monitored for a period of five years to ensure that it complies with all federal healthcare program rules.