Doctors Care, P.A. — South Carolina’s largest urgent care provider network — and its management company, UCI Medical Affiliates of South Carolina, Inc. (“UCI”), will pay $22.5 million to resolve civil allegations of healthcare fraud in violation of the False Claims Act. The case began with a whistleblower complaint alleging that Doctors Care, UCI, and UCI Medical Affiliates, Inc. (a related holding company), falsely certified that certain urgent care visits were performed by providers who were credentialed to bill Medicaid, Medicare, and TRICARE for medical services. Whereas, the services were performed by non-credentialed providers, according to the complaint. As early as 2013 and continuing to 2018, it is alleged that UCI was unable to secure and maintain necessary billing credentials for most Doctors Care providers. UCI knew that federal insurance programs would deny claims submitted with the billing number of a provider who had not yet received their billing credentials. But instead of solving its credentialing problem — or holding claims while a temporary solution could be found — UCI allegedly submitted the claims falsely, “linking” the uncredentialed rendering providers to credentialed billing providers in order to get the claims paid. With each “linked” bill, it is alleged that UCI knowingly submitted a false claim for payment.
