THE PHYSICIANS CLINIC OF SPOKANE RESOLVES CLAIM FOR OVERCHARGING MEDICARE
Spokane – Today, James A. McDevitt, United States Attorney for the Eastern District of Washington, announced that the Physicians Clinic of Spokane has paid the United States $656,000 to resolve allegations that it overcharged Medicare.
The United States contended that from March 2002 to March 2007, Physicians Clinic of Spokane (PCS) performed certain blood tests, that is, lipid panel tests and a cholesterol test without any intervening review to determine whether the second test was medically necessary. The second test (a Low Density Lipoprotein test) can only be billed to Medicare if it is performed after reading the first test results and then if it is determined to be medically necessary. Since the two tests occurred simultaneously, this was an improper testing and billing practice, according to Medicare’s rules and regulations.
While the United States contended that PCS was civilly liable for the overbilling, PCS denied the Government’s contentions. PCS cooperated with the United States’ demands that they end the disputed lipid panel billing practice. The parties also reached an agreed settlement in order to quickly and economically resolve the Government’s allegations of overbilling.
James A. McDevitt, U.S. Attorney for the Eastern District of Washington, said, “The Department of Justice and the Office of Inspector General continue to be vigilant in investigating and pursuing Medicare overbilling. The taxpayers’ money must be used only for proper and authorized purposes.”
“With the increased emphasis on health care reform and lowering costs, we need to hold Medicare service providers accountable for billing only for services that are medically necessary to maintain the integrity of the program,” said Sarah Allen, Special Agent in Charge for the U.S. Department of Health and Human Services, Office of Inspector General.
This settlement is part of the government’s emphasis on combating health care fraud. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover approximately $3 billion since January 2009 in cases involving fraud against federal health care programs.
This investigation was conducted by the Office of Inspector General of the Department of Health and Human Services and the U.S. Attorney’s Office. Jill Bolton, Assistant U.S. Attorney for the Eastern District of Washington, represented the United States.