An urgent care company has agreed to pay $2 million to settle whistleblower allegations that it submitted inflated claims to Medicare and Medicaid programs—known as “upcoding”—over a 5-year period in two New England states. Specifically, the Department of Justice charged that the company ordered its clinicians to examine and document multiple, specific body systems while taking the medical histories and performing physical exams, whether that level of attention was warranted by the patients’ complaints or not. The company was also accused of lying to its providers by telling them the unnecessary examinations were required by their malpractice insurance carrier. Prosecutors claimed the company failed to lower the amounts of claims for services rendered by unsupervised nurse practitioners, as well. The company cooperated with the investigation and ultimately agreed to the settlement deal, but maintained that it performed the tasks that were questioned in order to provide the most thorough care possible. The case is a reminder that there can be serious consequences if there’s even the appearance of impropriety when submitting claims for services rendered. It can also serve as a warning that any practice environment can be home to potential whistleblowers. Learn more about how to avoid getting caught up in such costly situations by reading What Exactly Are Whistleblower Lawsuits—and How Can You Protect Your Urgent Care Operation?, newly published in the April issue of JUCM, and now available on our website.


‘Upcoding’ Allegations Cost One Urgent Care Company $2 Million—Don’t Let It Happen to You
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