Federal government joins upcoding case against hospitalist company operating in LTC facilities

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The federal government has intervened in a whistleblower lawsuit alleging that a large hospitalist company systematically overbilled government health plans, the U.S. Department of Justice announced Monday.

Hospitalists are staff physicians who practice in acute or post-acute facilities and specialize in caring for these patient populations. They play an important role in coordinating care for patients in these settings and have an increasingly large presence in skilled nursing facilities, where they may be referred to as SNFists.

IPC The Hospitalist Company Inc. is one of the nation's largest hospitalist services, with physicians in about 800 post-acute facilities. The company faces charges that it encouraged its physicians to bill government insurance programs at the highest reimbursement codes regardless of what level of service was provided — a practice known as “upcoding.”

The charges initially were brought by a former IPC physician, Bijan Oughatiyan, M.D. After reviewing the case, the federal government decided to intervene, as it is allowed to do under the False Claims Act. That law also allows the government to recover three times the damages incurred plus civil penalties, the DOJ noted. The individual whistleblower shares in any damages recovered.

The government requested 120 days to file its own complaint in the case, which is being litigated in U.S. District Court in Chicago, according to the DOJ.

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