On August 27, the U.S. Attorney’s Office to the Western District of Kentucky reported that the Louisville Patient Centered Medical Home (LPCMH), paid $250,000 to resolve allegations that it had submitted false claims to Medicare, Medicaid, and TRICARE. The allegations were brought under the False Claims Act by a qui tam whistleblower, who claimed that LPCMH had defrauded the federal programs by improperly billing the services of nurse practitioners.
Allegedly, LPCMH billed the programs for services provided by nurse practitioners as if a physician had provided the services, resulting in fraudulent upcoding. According to the government, “Medicare, Medicaid, and TRICARE pay for medical services provided by nurse practitioners, but the amount of payment is different than if the service is provided by a physician.”
Medicare, Medicaid, and TRICARE provide health care and healthcare insurance to vulnerable members of the community. Medicare is intended for the elderly and disabled, and Medicaid offers insurance to low-income individuals and families. TRICARE provides healthcare to military personnel and their families. Exploiting these programs harms the integrity of the American healthcare system and disadvantages those who need the programs most.
The claim was filed under the qui tam provision of the False Claim Act. Under this provision, private individuals and organizations are empowered to file lawsuits on behalf of the government if they are aware of another private party or parties defrauding the government. Qui tam whistleblowers are eligible to receive between 15% and 30% of monies recovered.
Whistleblowers are integral to protecting healthcare programs’ valuable resources and preventing artificial inflation of the cost of care. The anonymous whistleblower(s) received more than $35,000 from this settlement.
U.S. Attorney Bumgarner stated, “This office is committed to investigating allegations of healthcare fraud and protecting federal healthcare programs. I appreciate the whistleblowers coming forward in this case and encourage others who see fraud to do the same.”
The claims resolved by settlement agreement are allegations only. There has been no determination of liability.
