Chronic disease management provider to pay $14.9 million to resolve alleged false claims – Detroit Lakes Tribune

MINNEAPOLIS – Bluestone Physician Services of Florida LLC, Bluestone Physician Services, PA and Bluestone National LLC, operating in Florida, Minnesota and Wisconsin, respectively, have agreed to pay $14,902,000 to resolve allegations that they knowingly submitted claims for certain evaluation and management (E&M) codes for services related to the management of chronic patients in assisted living and other care facilities that were not provided in accordance with applicable Medicare, Medicaid, and TRICARE requirements.

“Improper billing of federal health care programs depletes valuable government resources used to provide medical care to millions of Americans,” said Principal Assistant Attorney General Brian M. Boynton, chief of the Department of Health's Civil Division. Justice. “We will pursue health care providers who defraud taxpayers by knowingly submitting inflated claims. »

The settlement resolves allegations that, between January 1, 2015 and December 31, 2019, Bluestone knowingly submitted claims for two E&M codes, the Nursing Home Home Visit for Established Patients code (99337) and the chronic care management code. (99490), which did not support the level of service provided. The federal government's share of the settlement is $13,842,482 and $1,059,518 will be paid to the states of Florida and Minnesota.

“Fraudulent billing undermines the integrity of government health care programs and diminishes legitimate services and resources for Minnesotans,” said United States Attorney Andrew M. Luger for the District of Minnesota. “Health care companies that implement unnecessary billing and updating practices will be held accountable for their misconduct. »

“Submitting false claims to Medicare for chronic care services will not be tolerated in the Middle District of Florida,” said United States Attorney Roger B. Handberg for the Middle District of Florida. “This resolution sends a message to the provider community and our district that we will actively investigate and prosecute this type of behavior whenever it occurs. »

“When health care providers submit false claims to taxpayer-funded federal health programs, including inappropriately inflated claims to increase profits, public trust in our nation's medical providers and the “The integrity of federal health care programs is at risk,” the special agent said. official Mario M. Pinto of the Department of Health and Human Services, Office of Inspector General (HHS-OIG) Chicago Regional Office “We will continue to work with our law enforcement partners to ensure that those who engage in the alleged conduct. in this case, are held responsible. Additionally, the OIG's five-year compliance agreement is intended to ensure that the alleged conduct will not recur.

As part of the settlement, Bluestone entered into a five-year Corporate Integrity Agreement (CIA) with HHS-OIG, which requires Bluestone, among other obligations, to establish and maintain a compliance program meeting certain requirements and to submit to an independent review. The organization's review of Bluestone's Medicare claims to determine whether those claims were medically necessary, properly documented, and correctly coded.

Civil settlement includes the resolution of claims filed under the qui tam or the whistleblower provisions of the False Claims Act by Lisa Loscalzo, former general manager of Bluestone's Florida market. Under these provisions, a private party may bring an action on behalf of the United States and receive a portion of any recovery. THE qui tam the case is subtitled United States ex rel. Loscalzo v. Bluestone Physician Services of Florida, Bluestone Physician Services, PA, Bluestone National, LLC et al., 20-cv-295-FtM-38NPM (MD Fla). The civil settlement also includes the resolution of related allegations investigated by the U.S. Attorney's Office for the District of Minnesota. Ms. Loscalzo will receive $2,831,380 as part of the settlement.

The resolution achieved in this case was the result of a coordinated effort between the Department of Justice's Civil Division, the Commercial Litigation Branch, the Fraud Section, and the U.S. Attorneys' Offices for the District of Minnesota and the Middle District of Florida , with assistance from HHS-OIG. , the Defense Criminal Investigative Service and the FBI.

The investigation and resolution of this case illustrates the government's focus on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from any source regarding potential fraud, waste, abuse, and mismanagement can be reported to HHS at 800-HHS-TIPS (800-447-8477).

Trial Attorneys Erin Colleran and Joanna Persio of the Civil Division's Fraud Section, Assistant U.S. Attorneys Kristen E. Rau and Emily Peterson for the District of Minnesota, and Assistant U.S. Attorney Kelley Howard-Allen for the Middle District from Florida took care of the matter.

Claims resolved by the settlement are allegations only. No responsibility has been determined.