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Pennsylvania Hospital Settles FCA Case on Overbilling Government Healthcare Programs

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 ([email protected]) or Chiharu Sekino ([email protected]). We can also be reached toll-free at (866) 540-5505.

Shepherd, Finkelman, Miller & Shah, LLP is a law firm with offices in California, Connecticut, Florida, New Jersey, New York, Pennsylvania and Wisconsin. SFMS is an active member of Integrated Advisory Group (www.iaginternational.org), which provides us with the ability to provide our clients with access to excellent legal and accounting resources throughout the globe. For more information about our firm, please visit us at www.sfmslaw.com.

Wolf, Alex. "Pa. Clinic, Docs Ink FCA Settlement Over False Billings." Law360. Portfolio Media, Inc. 17 Aug. 2016. Web. 

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