The Florida, Minnesota, and Wisconsin-based Bluestone Physician Services has agreed to pay $14.9 million to resolve accusations that it purposefully filed false claims for services pertaining to the treatment of patients in chronic care. The U.S. Department of Justice announced the settlement, which covers claims that were discovered to be out of compliance with TRICARE, Medicare, and Medicaid regulations that were submitted between January 1, 2015, and December 31, 2019.
Nature of the Allegations
The misuse of Evaluation and Management (E&M) codes is at the heart of the accusations made against Bluestone Physician Services. The two codes in question were the chronic care management code (99490) and the domiciliary rest home visit code (99337) for established patients. It was discovered that these codes were abused to justify unfulfilled service levels, which resulted in exaggerated claims and incorrect invoicing procedures.
Impact on Government Resources
Chief of the Justice Department’s Civil Division, Principal Deputy Assistant Attorney General Brian M. Boynton, stated that “incorrectly billing federal health care programs depletes valuable government resources used to provide medical care to millions of Americans.” This quote highlights how fraudulent billing methods have a wider effect by taking money away from necessary and appropriate healthcare services.
Details of the Settlement
The federal government will receive $13,842,482 of the $14.9 million settlement, while the states of Florida and Minnesota will receive $1,059,518. In addition to correcting the incorrect billing methods, this resolution acts as a warning to other healthcare providers about potential fraud.
“Inauthentic invoicing compromises the credibility of public health care initiatives and reduces acceptable services and assets for Minnesotans,” stated U.S. Attorney Andrew M. Luger for the District of Minnesota.
Bluestone’s Corporate Integrity Agreement
Bluestone and the Office of Inspector General (HHS-OIG) of the Department of Health and Human Services have signed a five-year Corporate Integrity Agreement (CIA) in addition to the monetary settlement. In order to ensure that its Medicare claims are medically necessary, properly documented, and tagged, Bluestone is required by this agreement to design and maintain a compliance program that satisfies specific requirements and to submit to routine reviews by an Independent Review Organization.
Whistleblower Provisions and Qui Tam Case
The agreement also settles lawsuits filed by Lisa Loscalzo, the former general manager of Bluestone’s Florida market, under the False Claims Act’s qui tam or whistleblower provisions. Private parties may bring lawsuits on behalf of the government and be eligible to receive a portion of the settlement thanks to the qui tam rules. A portion of the compensation, $2,831,380, will go to Ms. Loscalzo. Important problems with Bluestone’s billing procedures were brought to light in her case, which was captioned U.S. ex rel. Loscalzo v. Bluestone Physician Services of Florida, Bluestone Physician Services, P.A., Bluestone National, LLC et al.
Government Efforts Against Healthcare Fraud
A concerted effort by several agencies, including the FBI, the Defense Criminal Investigative Service, HHS-OIG, the U.S. Attorneys’ Offices for the District of Minnesota and the Middle District of Florida, and the Justice Department’s Civil Division, led to the resolution of this case. This partnership is an example of how serious the government is about stopping healthcare fraud and prosecuting those who do it.
The public’s trust in our country’s medical providers and the integrity of federal health care programs are put at risk when health care providers submit false claims to taxpayer-funded federal health care programs, including improperly inflating claims to boost profits, according to Special Agent in Charge Mario M. Pinto of the HHS-OIG Chicago Regional Office. The goal of the CIA and settlement is to rebuild public confidence by stopping similar behavior from happening again.
The lawsuit against Bluestone Physician Services serves as a reminder of the serious repercussions of illegal billing methods as well as the significance of adhering to federal healthcare program regulations. The creation of a Corporate Integrity Agreement and the significant financial settlement serve as a clear reminder to healthcare providers about the importance of continuing to use truthful and accurate billing methods. The coordinated efforts of multiple government departments to resolve this issue demonstrate the continued dedication to safeguarding the integrity of healthcare initiatives and making sure that funds are allocated properly to benefit patients.
