The Alleged Overbilling Involved Tobacco Cessation Services and Advanced Care Planning
PHILADELPHIA – Acting United States Attorney Jennifer Arbittier Williams announced that Tri-County Hospitalists, LLC (“TCH”) has agreed to pay a total of $200,000 plus interest to resolve alleged violations of the False Claims Act by overbilling Medicare for advanced care planning (“ACP”) and tobacco cessation counseling (“TCC”) services. In many instances, TCH sought Medicare reimbursement for ACP and TCC services regardless of whether the counseling was necessary, voluntary, or performed with patient consent.
The settlement resolves allegations that, between January and September 2019, TCH engaged in a coordinated effort to defraud the United States by pressuring TCH personnel to seek Medicare reimbursement for ACP and TCC services for patients TCH treated, regardless of medical need. In most cases, the prerequisites for ACP and TCC services were not met and not every patient required the services that were billed. In some instances, TCH allegedly billed Medicare four or more times where ACP services were provided to a single patient over a short time frame with no evidence of any documented changes in patient condition to justify its billing activities. TCH also allegedly unnecessarily sought and received Medicare reimbursement for tobacco cessation counseling where patients did not use tobacco.
TCH is a physician-owned medical group that employs over 75 health care providers, also referred to as hospitalists, who specialize in internal medicine, family practice, pulmonary medicine, hospital medicine, emergency medicine and cardiology. TCH has offices in Philadelphia, Montgomery, and Chester Counties and provides its services in hospitals, skilled rehabilitation facilities, outpatient practices, and urgent care centers.
“Receiving payments from Medicare while providing medically unnecessary services to patients who rely on their doctors for their professional judgment cheats patients and defrauds the federal government,” said Acting United States Attorney Williams. “This resolution represents our commitment to holding accountable those who engage in fraud that affects the residents of this city and this district.”
The allegations were brought by a former TCH hospitalist under the qui tam (or whistleblower) provisions of the False Claims Act. The qui tam provisions permit private parties to sue for false claims on behalf of the government and to receive a share of any recovery. The relator was represented by Christopher J. DelGaizo, Esquire of the Derek Smith Law Group, PLLC.
The government’s pursuit of these matters illustrates its emphasis on combating healthcare fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services, at 1-800‑HHS‑TIPS (1-800-447-8477).
This case was investigated by the U.S. Attorney’s Office for the Eastern District of Pennsylvania with assistance by Auditor Dawn Wiggins. The lawsuit is captioned United States ex rel. Zeth Holbert v. Tri-County Hospitalists, LLC (“TCH”) et al., Civil Action No. 19-4099.
The claims resolved by this settlement are allegations only and there has been no determination of liability.
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