An urgent care network in South Carolina is learning the hard way that failing to maintain and submit accurate medical claims can lead to disastrous outcomes for the operator. The Justice Department just announced that the company in question will have to pay $22.5 million to resolve charges that it violated the False Claims Act. The state’s case rests on accusations that between 2013 and 2018 there were numerous instances in which the company billed government insurers for care that was provided by noncredentialed providers, but credited to credentialed clinical employees. Evidence presented included emails and “cheat sheets” the company used to track which providers were currently credentialed, and who were to be noted as the treating clinicians whether they actually saw a given patient or not.
Intentional or Not, Erroneous Claims Could Cost You Millions—and Maybe Your Business