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.
