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Press Release

United States Reaches $9.1 Million Civil Settlement with Total Access Urgent Care Over False Claims Allegations

For Immediate Release
U.S. Attorney's Office, Eastern District of Missouri

ST. LOUIS – The U.S. Attorney’s Office for the Eastern District of Missouri announced today that Total Access Urgent Care (TAUC) has agreed to pay $9,150,794 to settle allegations that TAUC submitted false claims for medical services, including COVID-19 testing.

“This settlement will fully repay three federal health care programs for TAUC’s overbilling for COVID tests and office visits,” said U.S. Attorney Sayler A. Fleming.

According to the United States’ allegations, from April of 2017 through November of 2021, TAUC submitted claims for payment to Medicare and TRICARE indicating that a physician performed office visits when a non-physician practitioner had actually done so, thereby receiving reimbursement at a higher rate.  From November of 2015 through November of 2021, TAUC submitted claims to Medicare and TRICARE for office visits that were upcoded. During the latter portion of that period, it also submitted upcoded office visit claims to a program that reimbursed for the testing or treatment of, and vaccination against, COVID-19 for people who were uninsured, the Health Resources and Services Administration’s COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured Program (UIP), the government alleges. TAUC voluntarily disclosed during the investigation that from April 1, 2021 through Dec. 31, 2021, it submitted false claims to Medicare, TRICARE and the UIP for COVID testing using improper billing codes, again receiving reimbursements at a higher rate.  

All of these false claims resulted in TAUC receiving reimbursement from federal health care programs to which it was not entitled, the government alleges.  

TAUC fully cooperated in the investigation. The company did not admit liability in the settlement agreement.

The settlement also resolved TAUC’s self-disclosure made in March of 2021 to the Centers for Medicare & Medicaid Services in which TAUC reported that bonuses paid to certain physicians it employed were in part based on the volume or value of their referrals for designated health services, a prohibited practice. 

“Today’s outcome illustrates HHS-OIG’s unwavering commitment to detecting, investigating, and shutting down fraud against Medicare, the HRSA Uninsured Program and protecting federal health care programs under any circumstance — especially during a public health emergency,” said Acting Special Agent Curt L. Muller from the U.S. Department of Health and Human Services Office of Inspector General.  “Our agency, working with our law enforcement partners, will continue to investigate health care fraud schemes, including those involving providers submitting fraudulent claims in violation of the False Claims Act.”

“When actors within our healthcare system are focused on profit rather than patient care, it undermines the integrity of the medical decision-making process,” said Gregory P. Shilling, Acting Special Agent-in-Charge of the Department of Defense Office of Inspector General’s Defense Criminal Investigative Service (DOD-OIG-DCIS), Southwest Field Office. “DCIS remains steadfastly committed to rooting out fraud and safeguarding the funds entrusted to the Defense Health Agency, which serves our military members and their families.”

This civil settlement is part of ongoing efforts by the Department of Justice and the U.S. Department of Health and Human Services to recover funds diverted from the Medicare Trust Account and is the result of the combined work of the U.S. Attorney’s Office for the Eastern District of Missouri, HHS-OIG, DOD-OIG-DCIS, and the FBI.

Contact

Robert Patrick, Public Affairs Officer, robert.patrick@usdoj.gov.

Updated December 21, 2023

Topic
Health Care Fraud