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U.S. Intervenes in False Claims Act “Upcoding” Action

Posted in Fraud and Abuse, Hospitals and Institutions, Litigation, Medicare and Medicaid, Reimbursement Matters, White Collar

Day Pitney’s July 2014 White Collar Roundup included the following item relating to the pending whistleblower case against IPC The Hospitalist Company, Inc.

The Department of Justice has filed its complaint, intervening in a noteworthy False Claims Act (FCA) suit pending in the U.S. District Court for the Northern District of Illinois. According to this press release, the defendant is “one of the largest hospitalist companies in the United States” and is alleged to have encouraged physicians to seek “payments for higher and more expensive levels of medical service than were actually performed,” which is commonly referred to as “upcoding.” The government alleges that the hospital “pressured and encouraged its physicians to engage in systematic overbilling of the codes submitted to the government health benefit programs.” The press release touts “the government’s emphasis on combating health care fraud” and its having recovered more than $17 billion through FCA cases.

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