IPC Hospitalists of Michigan, Inc., Inpatient Consultants of Michigan, P.C., IPC Healthcare f/k/a IPC The Hospitalist Company, and Team Health Holdings, Inc. (defendants) have agreed to pay a total of $4,384,618 to the United States and the State of Michigan to resolve allegations that they violated the False Claims Act by upcoding inpatient hospital services, allowing their doctors to bill for more services than they could possibly provide in one day, and billing for services not rendered, announced United States Attorney Dawn N. Ison. The State of Michigan will receive $606,483 of the settlement amount based on its share of alleged damages to the Medicaid program.
The settlement announced today resolves three sets of allegations. The first is that the defendants’ doctors regularly upcoded certain Current Procedural Terminology (CPT) codes typically used to report the most complex services relating to the evaluation and management of hospitalized patients. Upcoding is alleged fraudulent medical billing in which a claim is submitted for payment regarding a service that is more expensive than the service that was actually performed. The second set of allegations is that the defendants allowed their hospitalists to regularly bill for impossible days within the State of Michigan. An impossible day occurs when a hospitalist purports to provide such a high volume of inpatient services or procedures in one day that there is no way the hospitalist reasonably could have performed them all. The third set of allegations concern services and procedures purportedly rendered by the same provider, on the same day, and billed to the Medicare and Medicaid programs for beneficiaries located in Michigan and Indiana, which the government contends were not rendered to the Michigan-based beneficiaries.
