On June 7, the U.S. Department of Justice (DOJ) announced a $12 million False Claims Act (FCA) settlement with CityMD, the largest provider of urgent care practices across New York and New Jersey, over allegations that CityMD submitted false claims to a federal program for uninsured COVID-19 patients.
During the COVID-19 pandemic, a Health Resources and Services Administration (HRSA) program provided claims reimbursement to healthcare providers who provided treatment and testing for COVID-19 patients who were uninsured.
According to the DOJ, “from Feb. 4, 2020, through April 5, 2022, CityMD knowingly submitted or caused to be submitted false claims for payment for COVID-19 testing to the Uninsured Program for individuals who had health insurance coverage when CityMD administered those tests.”
“Uninsured Americans who were at risk from COVID-19 were covered by emergency funding programs that made available to them the testing, vaccines, and treatments that they needed,” said U.S. Attorney Philip R. Sellinger for the District of New Jersey. “The alleged misuse of these funds is something we cannot and will not tolerate. Today’s settlement ensures that the money that was obtained inappropriately will be returned to the government.”
The settlement stems from a qui tam lawsuit filed by Stephen Kitzinger, a patient of CityMD. Under the FCA’s qui tam provisions, individuals with knowledge of fraud may file lawsuits on behalf of the government. In successful qui tam cases, whistleblowers are eligible to receive between 15-30% of a settlement.
In this case, Kitzinger is set to receive approximately $2 million as his share of the recovery.
“The Uninsured Program provided critical financial support for COVID-19 related testing and treatment for uninsured Americans during the height of the pandemic,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “Today’s settlement reflects the department’s commitment to ensuring that the pandemic relief programs created by Congress were used as intended.”
In May 2021, the DOJ announced the establishment of the COVID-19 Fraud Enforcement Task Force. The Task Force aims to “marshal the resources of the Department of Justice in partnership with agencies across government to enhance enforcement efforts against COVID-19 related fraud.”
On July 25, a bipartisan group of senators introduced the False Claims Amendments Act of 2023, which address a few technical loopholes undermining the success of the FCA. The bill is widely supported by whistleblower advocates.
National Whistleblower Center (NWC) has issued an Action Alert calling on Congress to pass the bill.
Join NWC in Taking Action:
Demand that Congress strengthen the False Claims Act
Further Reading:
CityMD Agrees to Pay Over $12M for Alleged False Claims to the COVID-19 Uninsured Program
Bipartisan Legislation Unveiled to Strengthen False Claims Act