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DOJ settlement
with visiting physicians

Visiting Physicians Association to Settle False Claim Act Violations

by Astrid Fiano , DOTmed News Writer
The U.S. Department of Justice (DOJ) reports that Visiting Physicians Association (VPA), based in Farmington Hills, MI, will pay the United States and the state of Michigan $9.5 million to settle allegations of False Claims Act violations.

The settlements will resolve four qui tam (brought by whistleblowers, known as "relators") lawsuits under the False Claims Act. The federal statute allows relators on fraudulent claims to initiate a lawsuit under the act on behalf of the United States. The plaintiff-relators may also share in any recovery. The plaintiffs in this case will collectively receive approximately $1.7 million, the DOJ says.

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The VPA is alleged to have submitted false claims to Medicare, TRICARE (the health care program for active duty service members, reserves, retirees and dependents) and the Michigan Medicaid program. Visiting Physicians Association provides in-home physician services (including diagnostic and laboratory testing) for home-bound and disabled patients in the states of Michigan, Ohio, Georgia and Wisconsin. Medicare-qualified patients have such services billed through VPA for Medicare reimbursement.

Based on details from the publicly available qui tam complaints, the Visiting Physicians Association is alleged to have: improperly certified patients as homebound; required "upcoding" visits for laboratory fees and echocardiograms in order to obtain the maximum charge reimbursable by Medicare; required physicians hired by VPA to routinely see patients and order medical tests or procedures that were unnecessary; required physicians to visit patients more than medically necessary; required upcoding for moderate to high problems and high intensity visits when the patients did not meet the criteria; self-referrals of tests, medical goods and services to entities owned, controlled or associated with the defendants; and termination of employees after the employees complained of fraudulent practices.

"This settlement illustrates the government's commitment to pursuing those who defraud Medicare and other important programs and drive up the costs of health care," said Tony West, Assistant Attorney General for the Civil Division of the DOJ, on the agency's website. "The Justice Department will continue to work with our federal and state partners to ensure that taxpayer dollars are spent on health care services for patients, not wasted on fraud and abuse."

Adapted in part from a DOJ press release.

The DOJ release: http://www.justice.gov/opa/pr/2009/December/09-civ-1377.html

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