Family physician Dr. Chang-Wen Chen and his practice Chang-Wen Chen, M.D., P.C. paid $285,000 to resolve allegations that they violated the False Claims Act by improperly charging government healthcare programs the physician’s rate for services that were provided by nurse practitioners. The allegations challenged billings submitted to Medicare, Medicaid (“TennCare”) and TRICARE from 2013 through 2019. Medicare and TennCare reimburse at the higher physician rate for services provided by nurse practitioners or other non-physician providers when the services are rendered “incident-to” a physician’s services, but only if the physician provides direct supervision. TRICARE always pays the reduced rate for services rendered by non-physician providers regardless of whether a physician supervises. The government alleged that Dr. Chen’s practice unlawfully billed government payors at the physician rate even when services were rendered by unsupervised nurse practitioners. Under the False Claims Act, any person who presents false claims for payment to the United States is liable for three times the damages the government incurs as a result of the false claims and penalties ranging from $5,000 to $22,363 per violation, depending on when the violations occurred.
