FOR IMMEDIATE RELEASE
TUESDAY, SEPTEMBER 29, 1998
TDD (202) 514-1888
EMERGENCY PHYSICIAN STAFFING COMPANIES TO PAY
$3.1 MILLION FOR HEALTH CARE BILLING FRAUD
WASHINGTON, D.C. - Three companies which provide emergency physician staffing will pay the United States and eleven states more than $3.1 million to settle allegations that the companies submitted false claims through their billing company and received overpayments based on the claims, the Department of Justice announced today.
Assistant Attorney General Frank W. Hunger of the Civil Division and U.S. Attorney in Oklahoma City Patrick M. Ryan announced that Spectrum Emergency Care, Inc., Coordinated Health Services, Inc., and Synergon, all owned by Spectrum, will pay $3,145,494 to resolve allegations that they engaged in a scheme to submit false bills to the Medicare, Medicaid and TRICARE programs, as well as the Federal Employees Health Benefits Program (FEHBP).
The eleven states, Arkansas, Louisiana, Maryland, Massachusetts, Michigan, New Jersey, New York, Pennsylvania, West Virginia, New Hampshire and Texas, will collectively receive $381,584 from Spectrum under the agreement.
Hunger said Spectrum hired an Oklahoma City billing company, known as Emergency Physicians Billing Services (EPBS), to submit claims on its behalf to federal and state health care programs. EPBS then submitted Medicare, Medicaid, TRICARE, and FEHBP claims on Spectrum's behalf for patients seen by Spectrum physicians. The United States alleged that EPBS typically upcoded claims and billed for services more extensive than those actually provided by Spectrum's physicians.
The agreement, filed in U.S. District Court in Oklahoma City, settles a dispute originally brought by Theresa Semtner against Spectrum under the False Claims Act. As part of the settlement, the estate of Semtner, who filed the suit as a "relator" on behalf of the United States, will receive approximately $552,781. The sum is in addition to $1,547,394 the estate received from two earlier settlements with other defendants in the action.
The United States proceeded to trial in U.S. District Court in Oklahoma City in a civil case against EPBS and its chairman, J.D. McKean, M.D., and is awaiting the court's decision.
The case was conducted by the Civil Division and the U.S. Attorney's Office in Oklahoma City, with the assistance of HHS Office of Inspector General in Washington, D.C., and Dallas, Tex.; the Oklahoma City office of the Federal Bureau of Investigation; the Tulsa Resident Agency of the Defense Criminal Investigative Service; the Program Integrity Branch of the TRICARE Program, the United States Department of Defense; the Office of Inspector General for the Office of Personnel Management in Washington, D.C.; and various State Attorney General Medicaid Fraud Control Units around the country.
Additional audit support was provided by Xact, the Medicare intermediary in Pennsylvania, and the Mailhandlers Plan of the FEHBP.