Federal prosecutors filed a civil lawsuit against a California hospitalist company for allegedly overcharging government programs for physician care, the U.S. Department of Justice announced last week.
Hospitalists are doctors whose primary professional focus is inpatient medicine in hospitals and other long-term care facilities. Authorities allege IPC The Hospitalist Company, Inc. overbilled for evaluation and management services including admissions, subsequent hospital visits and discharges.
The government accuses IPC not only of knowing that its doctors overcharged, but also of instructing them to claim payment for the highest level of care regardless of whether they provided it.
"As a result of corporate/management pressure, and/or in keeping with IPC corporate culture and expectations to maximize billings," the lawsuit states, "IPC hospitalists have routinely and systematically submitted upcoded claims for payment to the United States."
The original complaint was part of a lawsuit filed in 2009 under the whistleblower provisions of the False Claims Act by Bijan Oughatiyan, a Dallas doctor formerly employed by IPC.
IPC is one of the nation's largest hospitalist organizations, employing more than 2,500 providers in more than 1,300 facilities in 28 states, the announcement stated.
IPC's reported revenues topped $600 million last year, according to the Los Angeles Times. More than half of the company's earnings have historically come from government business, the DOJ noted, including Medicare and Medicaid, TRICARE, the Federal Employee Health Benefits Program and the Railroad Retirement Medicare Program. IPC filed more than 5 million Medicare claims since 2003 and charged way more than the national average, the LA Times reported.
While the government seeks unspecified damages, the lawsuit may result in an eight-figure recovery, one of Oughatiyan's lawyers told the LA Times.
Spokeswoman Elaine Murphy told the Associated Press that IPC is cooperating with the DOJ.