Team Health Holdings, Inc. has agreed to pay $60 million to resolve a lawsuit alleging that a company it acquired in 2015 engaged in a long-running "upcoding" scheme. The suit, filed by Goldberg Kohn on behalf of a former IPC employee, claimed that the company intentionally and systematically billed Medicare, Medicaid and other government healthcare programs for higher and more expensive levels of medical services than its physician-hospitalists actually provided.
The allegations against IPC were originally brought to the government's attention through Goldberg Kohn's lawsuit on behalf of Dr. Bijan Oughatiyan, a former IPC employee, under the qui tam, or whistleblower, provisions of the False Claims Act, which encourages private citizens to report fraud against the government by allowing them to sue on behalf of the government and receive a share of any recovery. The Department of Justice filed its own complaint-in-intervention against IPC in 2013 to join and prosecute the matter under the False Claims Act.
Both the DOJ and Dr. Oughatiyan alleged that IPC knowingly submitted inflated (upcoded) claims for reimbursement to government health care programs for services provided by its affiliated physician-hospitalists. According to the lawsuits, IPC trained and encouraged its hospitalists to bill for their services at the highest possible levels without regard for the services actually rendered. IPC hospitalists rarely used less expensive codes, and in many cases billed for more services in one day than could possibly have been provided in a 24-hour period.
Goldberg Kohn, working alongside government attorneys from the DOJ and the United States Attorneys' Office for the Northern District of Illinois, prosecuted the case against IPC for years before Team Health agreed to resolve the matter for $60 million on February 6, 2017.
"We are very proud to represent Dr. Oughatiyan, who had the integrity and courage to come forward, and the conviction to see the case through to the end," said a Goldberg Kohn representative. "He saved American taxpayers many millions of dollars by putting a stop to IPC's scheme. "
The government's legal team was comprised of Elizabeth Rinaldo, Senior Trial Counsel at the Department of Justice; David Lidow, a former Assistant United States Attorney for the Northern District of Illinois; and Eric Pruitt, an Assistant United States Attorney for the Northern District of Illinois.
"This case highlights the value and power of an effective relationship between government and private counsel in fighting fraud against the government," a Goldberg Kohn representative said. "The government's legal team was brilliant from beginning to end. Eric Pruitt led the smart and effective investigation into Dr. Oughatiyan's allegations, leading to the government's decision to join the case with a powerful complaint-in-intervention. David Lidow skillfully directed the successful prosecution of the case, and Elizabeth Rinaldo's investigative, litigation, and legal talents were invaluable from the first days of the investigation to the conclusion of the case."
The lawsuit is United States of America ex rel. Bijan Oughatiyan v. IPC the Hospitalist Company, Inc., et al., Civil Action No. 09 C 5418 (N.D. Ill.).