On Wednesday, June 7th, 2017, the Department of Justice announced that Texas-based Union Treatment Center (UTC) will settle allegations of civil health care fraud for $3 million, and will be permanently excluded from federal health care programs. The allegations, brought under the qui tam provision of the False Claims Act, state that UTC improperly billed the Department of Labor’s Office of Workers’ Compensation Programs for workplace injuries. As a company that marketed itself as a specialist in treating workplace injuries, UTC reportedly sought to maximize payments from the Federal Employees’ Compensation Act (FECA) program by billing for services that never took place, overcharging for medical examinations, falsifying the time patients spent in therapy, and charging for unnecessary services and supplies. UTC was also accused of a comprehensive kickback scheme in exchange for patient referrals. The settlement partially resolves the False Claims Act lawsuit, and the qui tam relator’s compensation remains to be announced.
On Friday, June 2nd, 2017, the Department of Justice announced that Fredericksburg Hospitalist Group (FHG) and 14 of its member shareholders will pay $4.2 million to settle allegations of violating the False Claims Act through fraudulent billing. According to the whistleblower complaint, FHG deliberately upcoded evaluation and management (E&M) codes to their highest levels prior to submitting the claims to Medicare and other federal health insurance programs. The DOJ asserts that the fraudulent practices unnecessarily inflated the amount of money reimbursed to FHG from federal healthcare payors. The qui tam relator’s percentage of the whistleblower settlement has not yet been disclosed.