The federal government has joined in a whistleblower lawsuit alleging that a large hospitalist company engaged in systematic “upcoding” of Medicare and Medicaid claims, the U.S. Department of Justice recently announced.
Hospitalists are staff physicians who practice in acute or post-acute care facilities and specialize in caring for these patients. They help coordinate 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 California-based 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. IPC accomplished this through training protocols and by urging its physicians with lower billing levels to meet higher targets, according to the charges.
The charges initially were brought by a former IPC physician, Bijan Oughatiyan, M.D. It is “rare” for a “successful doctor” to become a whistleblower in this type of case, said Oughatiyan’s attorney, Matthew Organ of Goldberg Kohn.
Under the False Claims Act, the government can choose to intervene in whistleblower actions. After announcing its intervention in this case in early December, the DOJ requested 120 days to file its own complaint.
IPC has begun “preliminary discussions with the federal government regarding resolution of the investigation and related case,” according to a Dec. 6 Securities and Exchange Commission filing. That filing also noted that 13 states involved in the investigation declined to intervene.
The company cannot comment on an ongoing legal matter, an IPC spokesperson told McKnight’s.