Court: Provider must face federal upcoding charges

Editor's Note: This story has been updated with a response from IPC.

A federal judge has ruled that a hospitalist company with thousands of post-acute care customers must face federal charges that it overbilled the Medicare and Medicaid programs millions of dollars. The judge ruled there was sufficient evidence in corporate emails and databases to validate the government's massive False Claims Act complaint filed in June 2014.

North Hollywood, CA-based IPC The Hospitalist Company failed to convince the U.S. District Court for the Northern District of Illinois to dismiss the government's claim on the grounds it didn't meet procedural details of where, how and who was involved in the alleged upcoding scheme. But it did succeed in convincing the court to dismiss FCA complaints against the firm's subsidiaries and affiliates.

The government's FCA allegations stemmed from a 2009 whistleblower complaint by a former IPC physician who alleged the firm pressured its clinicians to bill government health plans for more expensive services than were provided. IPC employs approximately 2,500 hospitalists (physicians specializing in hospital care) across 28 states. Under the False Claims Act, the government can recover three times its damages and up to $11,000 for each false claim submitted.

In court proceedings Feb. 17, the U.S. Attorney's office presented emails from IPC's compliance department acknowledging that the company should avoid publicly discussing its billing code rates, which “easily could lead to trouble.” The government also submitted evidence of IPC's “dashboard” metrics that tracked physician codings in real time and set alerts when physician codes dropped too low, rather than a typical fraud alert that would warn when physician codes were trending higher than average, according to published reports.

 

In a statement, IPC said it "has, and continues to, fully cooperate and work toward a resolution with the Department of Justice. Given the pending litigation, we cannot discuss it further at this time."