NextCare Inc., an Arizona-based company, has agreed to pay $10 million to settle
federal and state allegations that it submitted false claims, the Justice
Department announced today. NextCare is an owner of a chain of urgent care
facilities with locations in Arizona, Colorado, Texas, North Carolina, Ohio, and
Virginia.
The settlement resolves allegations that NextCare submitted false claims to
Medicare, TRICARE, and the Federal Employees Health Benefits Program, as well as
the Medicaid programs of Colorado, Virginia, Texas, North Carolina, and Arizona
by billing for unnecessary allergy, H1N1 virus, and respiratory panel testing.
The United States also alleged that NextCare inflated billings for urgent care
medical services in the years under review, a practice known as upcoding.
“This settlement demonstrates the Justice Department’s commitment to ensuring
that federal health care dollars are spent appropriately,” said Stuart Delery,
Acting Assistant Attorney General for the Civil Division. “Health care providers
who administer unnecessary services or who overcharge for care will be held
accountable.”
Anne M. Tompkins, U.S. Attorney for the Western District of North Carolina,
noted that, “Today’s $10 million settlement with NextCare demonstrates our
commitment to putting a stop to improper billing practices that exploit Medicare
and drain vital resources from our health care system. NextCare’s upcoding and
unnecessary medical testing wasted taxpayers’ dollars. This is a strong message
to companies and individuals who engage in such conduct. We are here, we are
watching, and we will use all of our resources to safeguard the integrity of
important public programs and protect consumers across the nation.”
Daniel R. Levinson, Inspector General of the Department of Health and Human
Services (HHS-OIG), added, “Providers who subject beneficiaries to unnecessary
medical testing, as alleged against NextCare, compromise the well-being of their
patients and squander federal health care funds.”
As a condition of the settlement, NextCare Inc. is also required to enter
into a Corporate Integrity Agreement with HHS-OIG under which the company will
be monitored for a period of five years to ensure that in the future it complies
with all federal healthcare program rules.
The allegations resolved by today’s settlement were initially raised in a
lawsuit filed against NextCare by former NextCare employee Lorin Cohen. Under
the False Claims Act, private citizens acting as relators can bring suit on
behalf of the United States and share in the recovery. Ms. Cohen will receive
$1.614 million as her share of the recovery.
This resolution is part of the government’s emphasis on combating health care
fraud and another step forward for the Health Care Fraud Prevention and
Enforcement Action Team (HEAT) initiative, a collaborative effort launched in
May 2009 by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the
Department of Health and Human Services (HHS). Settlements such as this one
emphasize both the Department of Justice and HHS’s commitment to the reduction
and prevention of Medicare and Medicaid financial fraud. Through the False
Claims Act alone, the Justice Department has recovered more than $7.7 billion
since January 2009 in cases involving fraud against federal health care
programs. The Justice Department’s total recoveries in False Claims Act cases
since January 2009 are over $11.3 billion.
This matter was handled jointly by the Civil Division of the United States
Department of Justice, the U.S. Attorney’s Office for the Western District of
North Carolina, the FBI, the North Carolina Attorney General’s Office, the
Office of Inspector General of the Department of Health and Human Services
(HHS-OIG), the TRICARE Management Activity, and the Office of Personnel
Management (OPM), which administers the FEHBP. The claims settled by this
agreement are allegations only, and there has been no determination of
liability.
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