Virginia's Fredericksburg Hospitalist Group and 14 of its shareholders will pay roughly $4.2 million to settle allegations they violated the False Claims Act through a five-year upcoding scheme, the Department of Justice announced.
The complaint, filed by a whistleblower, alleged FHG and its hospitalists intentionally upcoded evaluation and management codes to the highest code levels in billing Medicare, as well as other federal healthcare payers in connection with services rendered to patients at Mary Washington Hospital and Stafford Hospital. Intentionally increasing the level of the codes to the highest code levels yielded increased reimbursement amounts paid by the federal healthcare payers to FHG, the DOJ said.
The scheme ran from January 2010 through April 2015, the DOJ said. Under the False Claims ACt, the whistleblower, which are also sometimes referred to as relators, may be awarded up to 25 percent or more the recovery. There was no word on a final amount slated for the relator in this case.
"Rooting out fraudulent billing by healthcare providers is a priority," said Dana J. Boente, U.S. Attorney for the Eastern District of Virginia. "This office will continue to pursue such matters vigorously."