DETROIT – IPC Hospitalists of Michigan, Inc., Inpatient Consultants of Michigan, P.C., IPC Healthcare f/k/a IPC The Hospitalist Company, and Team Health Holdings, Inc. (defendants) have agreed to pay a total of $4,384,618 to the United States and the State of Michigan to resolve allegations that they violated the False Claims Act by upcoding inpatient hospital services, allowing their doctors to bill for more services than they could possibly provide in one day, and billing for services not rendered, announced United States Attorney Dawn N. Ison. The State of Michigan will receive $606,483 of the settlement amount based on its share of alleged damages to the Medicaid program.
Ison was joined in the announcement by Cheyvoryea Gibson, Special Agent in Charge of the FBI in Michigan and Special Agent in Charge Mario Pinto, Health and Human Services, Office of Inspector General (HHS-OIG).
The defendants are related companies that employ and provide hospitalists to Michigan hospitals. Hospitalists are doctors whose focus is the general medical care of hospitalized patients.
The settlement announced today resolves three sets of allegations. The first is that the defendants’ doctors regularly upcoded certain Current Procedural Terminology (CPT) codes typically used to report the most complex services relating to the evaluation and management of hospitalized patients. Upcoding is alleged fraudulent medical billing in which a claim is submitted for payment regarding a service that is more expensive than the service that was actually performed. The second set of allegations is that the defendants allowed their hospitalists to regularly bill for impossible days within the State of Michigan. An impossible day occurs when a hospitalist purports to provide such a high volume of inpatient services or procedures in one day that there is no way the hospitalist reasonably could have performed them all. The third set of allegations concern services and procedures purportedly rendered by the same provider, on the same day, and billed to the Medicare and Medicaid programs for beneficiaries located in Michigan and Indiana, which the government contends were not rendered to the Michigan-based beneficiaries.
“The False Claims Act is an important tool to deter and hold accountable those who submit fraudulent medical claims to the government,” said U.S. Attorney Dawn N. Ison for the Eastern District of Michigan. “Any allegation that a provider is billing for services not actually provided will be vigorously investigated by our office.”
“The submission of false claims to our Federal health care programs by individuals or institutions erodes the trust that we place in these providers and wastes valuable taxpayer dollars,” said Mario M. Pinto, Special Agent in Charge of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). “HHS-OIG remains committed to working with our law enforcement partners to ensure that those who submit false claims are held accountable.”
“We hope this settlement will bring some economic justice by requiring those responsible for this fraudulent scheme to pay for their actions,” said Cheyvoryea Gibson, the Special Agent in Charge of the FBI in Michigan. “Healthcare fraud is not a victimless crime. Whenever the integrity of our healthcare programs is compromised, everyone bears the cost through potentially higher insurance premiums, out-of-pocket expenses, and even reduced or lost benefits. It would not have been possible to unravel the complexities of this scheme fueled by greed without the assistance of our partner agencies, and we would like to express our gratitude for their assistance in our quest for justice.”
The civil settlement includes the resolution of claims brought under two separate qui tam or whistleblower lawsuits under the False Claims Act: United States ex rel. Saad v. IPC Hospitalists of Michigan, Inc., et al., Case No. 17-13656 (E.D. Mich.) and United States ex rels. Amine P. Amine and Redwan Asbahi v. Team Health Holdings, Inc., et al., Case No. 2:21-cv-10799 (E.D. Mich.). Under the False Claims Act, a private party can file an action on behalf of the United States and receive a portion of any recovery. Relator Chadi Saad will receive $571,900.00 as part of the settlement. Relators Redwan Asbahi and Amine Amine will receive $195,408 as part of the settlement.
The resolution obtained in this matter was the result of a coordinated effort among the United States Attorney’s Office for the Eastern District of Michigan, the Michigan Attorney General’s Health Care Fraud Division, the U.S. Department of Health and Human Services – Office of the Inspector General, and the Federal Bureau of Investigation. The matter was handled by Assistant United States Attorneys John Postulka and John Spaccarotella from the U.S. Attorney’s Office for the Eastern District of Michigan.
The investigation and resolution of this matter illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the U.S. Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).
The claims resolved by the settlement are allegations only; there has been no determination of liability.