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Urgent care provider convicted of healthcare fraud and ordered to pay $12.5 million

Press releases may be edited for formatting or style | September 08, 2020 Insurance
PHOENIX, Ariz. – Last week, UCXtra Umbrella, LLC, was sentenced by U.S. District Judge Michael T. Liburdi and ordered to pay $12,500,000 in restitution. UCXtra Umbrella, LLC, had previously pleaded guilty to health care fraud and engaging in monetary transactions derived from unlawful activity.

UCXtra Umbrella, LLC, which did business in Arizona under the name “Urgent Care Extra,” owned and operated a network of more than 30 urgent care centers, primarily in the Phoenix and Tucson areas. From 2012 through 2016, more than one million patient visits occurred at UCXtra clinics in Arizona.

As part of its guilty plea, UCXtra admitted that it intentionally created patient care practices and billing procedures that caused its providers and staff to overstate the complexity of the medical services provided to patients and claim falsely inflated reimbursement rates from health insurance companies. UCXtra also admitted that it encouraged providers and staff to order tests and procedures that may not have been medically necessary to justify higher billing codes and obtain higher reimbursement rates. The estimated loss to health insurance companies caused by UCXtra’s health care fraud scheme is $12,500,000.

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“Greed-driven schemes like this one drive up health care costs and hurt all Americans,” said United States Attorney Michael Bailey. “This excellent investigation by the FBI and IRS will send a clear message to health care providers that fraudulent billing will be held to account.”

The Federal Bureau of Investigation and Internal Revenue Service-Criminal Investigation conducted the investigation. Assistant United States Attorneys Peter Sexton and Bridget Minder handled the prosecution.

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