A medical clinic chain knowingly submitted more than 20,000 false Medicare claims from its North Texas locations, a jury ruled this week. And each individual allegation carries a statutory penalty, with the clinic chain potentially facing fines totaling more than $300 million.
A Dallas law firm has filed a lawsuit against a chain of clinics (Healthcare Associates of Texas, which operates eight clinics in North Texas, according to its website) for working in the clinic's billing office. filed suit on behalf of a whistleblower who discovered fraudulent charges when
“Like many health care providers, HCAT submits Part B reimbursement claims directly to the government,” the original complaint, filed in 2019, says. “Unlike most other health care providers, HCAT and its individual physicians and other employees engage in widespread fraud” and defraud the government of millions of dollars by submitting false and inflated claims. It's a plan. ”
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Attorneys for Texas Healthcare Associates issued a written statement in response to the jury's decision:
“HCAT complies with applicable Medicare billing regulations and continues to provide quality patient care. HCAT is disappointed with this ruling and intends to pursue all options.”
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Texas Healthcare Associates was acquired by parent company Optum for $300 million in 2022 and became part of WellMed. Optum is a subsidiary of UnitedHealth Group, which also operates insurance company UnitedHealthcare.
The clinic chain fired finance employee Cheryl Taylor after she raised concerns about her billing, according to the lawsuit, filed in the Dallas Division of the U.S. District Court for the Northern District of Texas.
A U.S. Department of Justice spokesperson declined to comment.
The lawsuit alleges that Texas Health Care Associates, Inc. billed medical services under qualified physicians and required various test panels and other tests when they were actually provided by subordinates. They allege that they fraudulently filed Medicare claims in a variety of ways, including by lying about their gender.
Texas Health Care Associates will bill Medicare for three separate annual health visits and look for ways to add excess tests and laboratory work, lawyers said. Such tests could be covered by Medicare if necessary, but “HCAT performed the tests no matter what and then sought ways to justify the claims,” the lawsuit says. is stated.
“To make matters worse, HCAT manipulated Medicare beneficiaries' medical records to conceal its inappropriate approach,” the filing states.
According to the complaint, there were more than 47,000 fraudulent claims from 2015 to 2021.
On Monday, a jury did not agree that all of the claims were fraudulent, but found that Texas Healthcare Associates knowingly filed 21,844 fraudulent claims, costing the government $2.8 million. The court ruled that the defendant was seeking compensation for damages.
Individual fraudulent claims also carry penalties ranging from approximately $14,000 to nearly $28,000 pursuant to the False Claims Act. That means the clinic chain could be forced to pay more than $304 million in fines to the federal government, although the judge has not yet announced the fine amount.
The jury also found that five employees of the clinic chain – David Harbor, Christian Daniels, Charles Powell, Walter Gaman, and Terrence Feely – conspired to violate the False Claims Act. did.
Robert Gifford, a partner at the Dallas law firm Johnston Clem Gifford and Taylor's lead attorney, said the whistleblower felt “vindicated” by the jury's verdict.
“She spent four or five years feeling like she was being told she was wrong. All she did was try to do the right thing,” Gifford said. . “She feels more relieved than happy, but she feels the process went well.”
Texas Healthcare Associates may appeal the ruling or settle with the plaintiffs.
The false claims filed by Texas Healthcare Associates are one of several common Medicare fraud schemes, said Charles Silver, a UT Austin Law School professor who specializes in health law.
“Essentially, anyone who sends a bill to the federal government for payment is tempted to commit fraud, and fraud is very widespread,” Silver said. “This makes sense in the healthcare field.”
In fiscal year 2023, the Department of Justice reported 543 settlements and judgments based on the False Claims Act, the highest number ever for a single year. Of the more than $2.68 billion reported in these settlements and judgments, more than $1.8 billion was related to the health care industry and returned to federal programs.
Texas parent company UnitedHealth Group Healthcare Associates is currently on trial in Los Angeles at the center of a $2 billion Medicare fraud case brought by the Department of Justice.
