Scripps Health, a San Diego-based health care system, will pay $1.5 million to resolve allegations of False Claims Act (FCA) violations. Scripps is accused of seeking reimbursements from federal health care programs for physical therapy services rendered by therapists who lacked billing privileges.
If you have any information regarding an individual or business within the health care industry providing the government with incorrect claims in order to increase their reimbursements, then contact a San Francisco health care fraud attorney at Brod Law Firm right away. You may have the right to bring a claim under the FCA or take your information to the proper authorities.
Unauthorized Physical Therapists
Federal health care programs, including Medicare and TRICARE, require that service providers have proper authorization or work under an appropriate enrolled physician. This is to ensure that patients relying on a federal health program only see qualified medical professionals.
When patients receive services from unauthorized medical professionals, these services must be billed as incidental to the services provided by an enrolled physician. However, this still requires the unauthorized professional to work under the supervision of the authorized professional.
However, Scripps is alleged to have billed Medicare and TRICARE for physical therapy services that were provided by unauthorized physical therapists without appropriate supervision. This, ultimately, led to Scripps receiving reimbursements it was not entitled to in violation of the FCA.
Scripps responded to the allegations with a statement saying that the improper billing arose due to a technical error in processing Medicare bills. The company states it reached a settlement to prevent any further legal expenses, and not to admitting guilt. It also stated that it discovered the error on its own and had self-reported it to Medicare, though it was unaware of the civil suit and federal officials were unaware of the self-disclosure.
Settlement Arose From Qui Tam Suit
The federal FCA is one of the government’s strongest tools against fraud and abuse of the system. It prohibits businesses or individuals from filing false or fraudulent claims with any government program. Health care is a common industry for FCA claims, though this law applies to any field.
The FCA also incentivizes having private individuals coming forward and protects them when they do. The Scripps settlement arose after Suzanne Forrest, a former Scripps employee, filed a qui tam suit under the FCA. A qui tam suit is one that is brought by a private individual on behalf of the federal or a state government. It derives from the phrase “qui tam pro domino rege quam pro se ipso in hac parte sequitur,” which means “he who sues in the matter for the king as well as for himself.”
A qui tam suit is for the whistleblower as well as the government because the individual who brings the suit, also known as the relator, can receive a part of any settlement or jury award the government receives. Forrest is set to receive $225,000 for her part in the case.
Do You Have Information About Health Care Fraud?
If you know of an individual or business in the health care industry who may be improperly billing a federal or state health care program, call an experienced attorney at Brod Law Firm today.
(image courtesy of Hush Naidoo)