EMERGENCY PHYSICIAN GROUP TO PAY U.S. & MICHIGAN $1.6 MILLION
FOR HEALTH CARE BILLING FRAUD

WASHINGTON, D.C. – An emergency physician group in Michigan will pay the

United States and the state of Michigan $1.6 million to settle allegations that the group submitted false claims through its billing company, the Department of Justice announced today. Today's settlement resolves allegations that the group, Medical Center Emergency Services, P.C., overcharged Medicare, Medicaid, the Department of Defense's TRICARE program and the Federal Employees Health Benefits Program (FEHBP).

The Department said that Medical Center Emergency Services hired Emergency Physicians Billing Services (EPBS) to submit claims on its behalf to federal and state health care programs. The Oklahoma City billing company then submitted false Medicare, Medicaid, TRICARE and FEHBP claims on the group's behalf for patients seen by Medical Center Emergency Services physicians. The Department said that EPBS typically upcoded claims and billed for services more extensive than those actually provided by the physicians.

"This settlement is yet another example of the United States' commitment to protecting federal funds from fraud and abuse committed by physicians and health care billing companies," said Assistant Attorney General Robert D. McCallum, Jr. of the Department's Civil Division.

The agreement settles a dispute with the group originally brought as a qui tam or whistleblower case in the United States District Court in Oklahoma City. As part of the settlement, the estate of Theresa Semtner, which filed the suit on behalf of the United States, will receive approximately $279,943. Ms. Semtner was a former employee of EPBS. This settlement is the latest in a series of settlements with other EPBS clients. The United States settled with EPBS in October 1999.

The case was conducted by the Justice Department's Civil Division with the assistance of the Office of the Inspector General, Department of Health and Human Services in Washington, D.C.; the Oklahoma City office of the FBI; 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 the Michigan Medicaid Fraud Control Unit.

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