NextCare Inc., an Arizona based owner of urgent care medical facilities, has settled False Claims Act allegations brought against the company by the Department of Justice. This $10 million settlement was announced on the heels of a $3 billion settlement with GlaxoSmithKline—the largest health care fraud settlement in history.
According to the complaint, filed under the qui-tam provisions of the False Claims Act, NextCare submitted false claims to numerous state and federal health care programs, including Medicare, TRICARE, the Federal Employees Health Benefits Program, and the Medicaid programs of Colorado, Virginia, Texas, North Carolina, and Arizona. The company allegedly performed unnecessary allergy, H1N1 virus, and respiratory panel testing and billed the various government programs for these tests.
Additionally, NextCare was accused of upcoding for urgent care services. Many medical procedures and supplies are billed to government-funded health care programs based upon codes. Upcoding occurs when a company provides a particular service to a patient, in this instance urgent care services, but uses a more expensive code when it bills for the service. This is a common type of health care fraud.
The Department of Justice was initially alerted to NextCare’s alleged fraud by whistleblower Lorin Cohen. Ms. Cohen is a former NextCare employee who was fired shortly before filing her qui-tam lawsuit in 2009. Ms. Cohen will receive $1.614 million as her share of the settlement recoveries.
For more information on reporting health care and other types of fraud, contact the qui-tam attorneys of Tycko & Zavareei today.