Government Intervenes in IPC Hospitalist Company Whistleblower Lawsuit with Florida Ties By Tod Aronovitz | 07/10/14 | 0 Comment

By filing a civil whistleblower lawsuit against IPC The Hospitalist Company and its subsidiaries, the U.S. Attorney’s Office announced that it is officially intervening in a whistleblower’s lawsuit which alleges that IPC submitted false claims to federal health care programs, including Medicare. When our ARONOVITZ LAW Blog reported on this case in December, the federal government declared its intent to join the suit when it was first unsealed.

Although based in North Hollywood, CA, IPC also provides care services throughout Florida including Miami-Dade County, Broward County, Palm Beach County, Jacksonville, Ocala, Southwest Florida, Tampa, and Orlando. A good portion of its 2,500 employees are hospitalists, or doctors who work only in hospitals and other long-term care facilities to administer inpatient care from admission to discharge. IPC, which is one of the largest hospitalist companies in the country, has more than 1,300 facilities across 28 states.

According to the government’s complaint in the whistleblower lawsuit, IPC allegedly violated the False Claims Act by deliberately overbilling for hospital evaluation and management services billed to federal health benefit programs—Medicare, Medicaid, the TRICARE Program, the Federal Employee Health Benefits Program, and the Railroad Retirement Medicare Program. Historically, more than half of IPC’s revenues have come from government medical insurers, the lawsuit points out.

IPC supposedly encouraged its physicians to bill at the highest levels—or “upcode”—regardless of the service provided and pressured them to “catch up” to their highest-billing peers. The lawsuit alleges that IPC knew, or should have known, that the highest-level billing codes were being used more frequently than normal, and contends that IPC physicians could not have actually carried out the services at the levels for which claims were submitted.

“IPC’s upcoding scheme caused, and still continues to cause, Medicare, Medicaid and other federal payors to overpay millions of dollars to IPC,” the suit states. “As a result of corporate/management pressure, and/or in keeping with IPC corporate culture and expectations to maximize billings, IPC hospitalists have routinely and systematically submitted upcoded claims for payment to the United States,” it adds.

Dr. Bijan Oughatiyan, who was employed as an IPC hospitalist in San Antonio from 2003 to 2008, originally filed the lawsuit in 2009 under the qui tam or whistleblower provisions of the False Claims Act. Federal law and similar state statutes permit private individuals to sue for false claims on behalf of the government and to share in any recovery. The Act also allows the government to intervene or take over the lawsuit, as it has done in this case, and to recover three times its damages plus civil penalties ranging from $5,500 to $11,000 for each false claim submitted.

How to Report Miami Medicare Fraud

Healthcare professionals or medical billing employees who have knowledge of questionable Medicare billing practices can file a confidential legal claim under the False Claims Act. By acting as a “whistleblower” in what is known as a “qui tam” lawsuit, a private party may collect up to 30 percent of the amount recovered, depending on how the case is prosecuted.

ARONOVITZ LAW: Miami Whistleblower / Qui Tam Law Firm

The Miami Qui Tam law firm of ARONOVITZ LAW routinely works with whistleblowers to document Medicare fraud and other forms of fraud against the government. Contact Miami Whistleblower / Qui Tam lawyer Tod Aronovitz to discuss your case.