Fredericksburg Hospitalist Group, P.C. (FHG) has agreed to fork over $4.2 million to settle a federal False Claims Act (FCA) case that alleged fraudulent billing practices.
RICHMOND, Va. – The settlement stems from allegations that FHG and 14 of its member shareholders intentionally upcoded evaluation and management (E&M) codes to the highest levels when billing Medicare and other federal healthcare payors for services provided at Mary Washington Hospital and Stafford Hospital.
According to Dana J. Boente, U.S. Attorney for the Eastern District of Virginia, ‘Rooting out fraudulent billing by healthcare providers is a priority,’ adding that his office will continue to pursue such matters with vigor.
The investigation into the matter revealed that from January 2010 through April 2015, FHG knowingly and intentionally increased E&M codes, resulting in inflated reimbursement amounts from federal healthcare payors.
‘Whether it’s upcoding, billing for undelivered services, or delivering substandard care, our Medicaid Fraud Control Unit will never cease in its efforts to protect taxpayers,’ said Virginia Attorney General Mark Herring.
The whistleblower, also known as a ‘relator,’ alleged that the defendants’ conduct violated the FCA. Under the FCA, relators may be awarded up to 25 percent of the amounts collected.
This resolution was a result of a coordinated effort between various federal and state agencies. Assistant U.S. Attorney Robert McIntosh, along with Assistants Vincent J. Vaccarella and Adele M. Neiburg, led the investigation. It’s important to note that the civil claims settled by this FCA agreement are allegations only, with no determination of civil liability.
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Key Facts
- State: Virginia
- Agency: DOJ USAO
- Category: Public Corruption|White Collar Crime
- Source: Official Source ↗
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