Qui Tam Whistleblowers Receive $767,000 for Exposing Alleged Upcoding Scheme

Upcoding Whistleblower

On October 17, the United States Attorney for the Eastern District of Michigan announced that IPC Hospitalists of Michigan Inc. has agreed to pay a total of $4,384,618 to settle allegations of violating the False Claims Act (FCA).

The case alleges that IPC Hospitalists of Michigan, Inc. engaged in upcoding of inpatient hospital services. As well as allowing their doctors to bill for more services than they could possibly provide in one day and for services that were not rendered.

This case stems from two qui tam whistleblower cases filed against IPC Hospitalist of Michigan Inc. The False Claims Act’s qui tam provisions allow private citizens to file lawsuits on behalf of the government if they know of an individual or company defrauding the government. Qui tam whistleblowers are eligible to receive between 15 and 30% of the government’s recovery. In this settlement, the whistleblowers are set to receive a total of $767,308.

“The submission of False Claims to our Federal health care programs by individuals or institutions erodes the trust that we place in these providers and wastes valuable taxpayer dollars,” said Mario M. Pinto, Special Agent in Charge of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). “HHS-OIG remains committed to working with our law enforcement partners to ensure that those who submit false claims are held accountable.”

“The False Claims Act is an important tool to deter and hold accountable those who submit fraudulent medical claims to the government,” said U.S. Attorney Dawn N. Ison for the Eastern District of Michigan. “Any allegation that a provider is billing for services not actually provided will be vigorously investigated by our office.”

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.

“The False Claims Act is America’s number one fraud-fighting law,” said whistleblower attorney Stephen M. Kohn. “These amendments are urgently needed to ensure that whistleblowers can continue to play their key role in protecting taxpayers from corporate criminals.”

Further Reading:

Hospitalist Companies Agree To Pay Nearly $4.4 Million To Settle False Claims Act Allegations

Bipartisan Legislation Unveiled to Strengthen False Claims Act

More False Claims Act Whistleblower News

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