KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Feds Join Whistleblower Suit

The Justice Department says in a lawsuit that IPC The Hospitalist Co., which assigns doctors to hospitals in 28 states, bilked Medicare and Medicaid by billing for more expensive care than was provided. Meanwhile, West Virginia could lose as much as $200 million in federal Medicaid funds because it contracts with providers facing "credible" fraud accusations, according to an audit.

Los Angeles Times: IPC The Hospitalist Defrauded Medicare And Medicaid, U.S. Lawsuit Says
In a lawsuit filed Monday in Chicago, federal lawyers said IPC The Hospitalist Co. bilked Medicare and Medicaid by billing for more expensive care than was provided. The company assigns doctors to hospitals in 28 states, then bills insurers, including government programs, for treatment they provide. The company reported $610 million in revenue last year (Pfeifer, 6/17).

Modern Healthcare:  Feds Join Whistleblower Suit Against Evaluation/Management Firm For Upcoding
The U.S. Justice Department has filed a complaint against IPC the Hospitalist Co. alleging the company actively encouraged physicians to upcode claims for routine patient evaluations for the past decade.  The government, joining a whistle-blower lawsuit filed by one of its physicians, alleges that North Hollywood, Calif.-based IPC has overbilled federal health care programs by upcoding for evaluation and management services since 2003. For example, the government said hospital-based physicians with IPC were billing a high-severity E&M code, 99233, at an average rate of 70 percent, while the national average is around 20 percent. That code pays almost $90, compared with $36 for a less-intensive code (Herman, 6/17).

Charleston (W.Va.) Daily Mail: Report: WV Could Lose Millions In Medicaid Money
West Virginia could lose roughly $230 million in federal Medicaid funding if it doesn’t stop sending payments to health care providers facing “credible” accusations of fraud, according to a new report provided to lawmakers Tuesday.The state Bureau for Medical Services sent that much money between March 2011 and June 2013 to providers accused of several different types of fraud, in violation of the Affordable Care Act, said Brandon Burton, an analyst with the office of the West Virginia Legislative Auditor (Boucher, 6/17).

Charleston Gazette: Audit Finds Medicaid Not In Compliance
West Virginia’s Bureau of Medical Services is not following a 2011 federal directive to suspend Medicaid payments to health-care providers accused of fraud, putting it at risk of losing between $17.9 million to $211 million in federal matching funds, a legislative audit released Tuesday warns.The audit notes that a 2011 amendment to the Affordable Care Act requires states to suspend Medicaid payments to providers once it is determined that an allegation of fraud is credible and is referred to the Medicaid Fraud Control Unit for investigation (Kabler, 6/17).

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