The Lehigh Valley Health Network ("Health Network") has reached an agreement to pay nearly $700,000 to the federal government to settle a qui tam lawsuit alleging that it violated the False Claims Act by overbilling multiple federal healthcare programs. Hospitals and treatment centers within Health Network were allegedly misrepresenting the medical services provided to patients, and billing programs such as Medicare, Federal Employees Health Benefits, and Workers' Compensation in excess of reimbursement policy allowances.
Regarding medical billing, the distinction of who performs the medical services determines what portion of the cost can be submitted for reimbursement by the government. Services performed solely by non-physicians are billed to government healthcare programs at a lower rate than those performed under a supervising physician.
The whistleblower alleged that Health Network submitted reimbursement claims for medical services provided by non-physicians "incident to" the work of a supervising physician. In reality, the lawsuit claimed, supervising physicians weren't involved in these services at all, and were occasionally out of the office when supposedly supervising non-physicians. These "incident to" false claims were allegedly being submitted from mid-2007 to late 2013.
Almost a fifth of the settlement amount will go to the whistleblower. In addition, the Defendant agreed not to submit any "incident to" reimbursement claims for the next two and a half years.
The legal team at SFMS has significant experience litigating FCA matters. If you have any questions regarding this subject or this posting, please contact Nick Lussier (firstname.lastname@example.org) or Chiharu Sekino (email@example.com). We can also be reached toll-free at (866) 540-5505.
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Wolf, Alex. "Pa. Clinic, Docs Ink FCA Settlement Over False Billings." Law360. Portfolio Media, Inc. 17 Aug. 2016. Web.