On April 8, 2021, the DOJ announced in a PRESS RELEASE that Doctors Care, P.A. – South Carolina’s largest urgent care provider network – and its management company, UCI Medical Affiliates of South Carolina, Inc. (“UCI”), will pay $25 million to resolve* civil allegations of healthcare fraud in violation of the False Claims Act.
Relators initiated the FCA action on August 8, 2017 with the filing of their original complaint. On September 18, 2017, Relators filed their Amended Complaint for False Claims Act Violations, a copy of which can be found below:
According to Relators’ Amended Complaint, Doctors Care and UCI:
(1) submitted false claims to Medicare, Medicaid, Medicaid Managed Care Organizations, Medicare Advantage, TRI-CARE, and other federal health insurance programs (“Federal Healthcare Programs”) for services that were provided by physicians and Nurse Practitioners and Physician Assistants (“Mid-Levels”) that were not credentialed as providers for the respective Federal Healthcare Programs. Doctors Care and UCI accomplished this by filling the services of non-credentialed providers under the NPI number and signature of various credentialed providers (who took no part in providing the care that was billed for).
(2) violated the “incident to” billing guidelines of the Federal Healthcare Programs and sought higher reimbursements for Mid-Levels despite the fact that physicians took no part in the Mid-Levels’ treatment.
(3) violated the “incident to” billing guidelines of the Federal Healthcare Programs by billing new patient visits provided by Mid-Levels under the signature of physicians who took no part in the treatment.
(4) submitted false and fraudulent claims for various medications and medical equipment.
(5) submitted false and fraudulent claims for Medicare Annual Wellness Visits.
On April 6, 2021, the United States filed its Notice of Election to Intervene and Joint Stipulation of Dismissal. The next day, the district court entered its Order of Dismissal. A copy of the foregoing documents can be found below:
- The claims resolved by the settlement are allegations only, and there has been no determination of liability.