Chronic health care provider to pay for alleged misrepresentations

A chronic disease management provider with multiple offices in Florida has agreed to pay $14.9 million to resolve alleged false claims.

The U.S. Department of Justice said Bluestone Physician Services of Florida LLC, Bluestone Physician Services, PA and Bluestone National LLC, operating in Florida, Minnesota and Wisconsin, respectively, recently agreed to the settlement.

The payment is $14,902,000 to resolve allegations that the provider knowingly submitted claims for certain assessment and management codes for services related to the management of chronic patients in assisted living facilities and other health care facilities that were not provided in accordance with applicable Medicare, Medicaid, and TRICARE regulations. requirements.

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. A corporate whistleblower involved in the case will receive more than $2.8 million.

A description of services on a Bluestone Physician Services website says the company has provided residential care to elderly patients in assisted living, memory care and group homes since 2006 and, in 2015, expanded the care in Florida.

The company description also states that Bluestone has offices in Tampa and Orlando and now serves communities in the Orlando, Jacksonville, Tampa and Sarasota areas. A corporate map on Bluestone's website also shows connections further south through Charlotte and into Lee County.

“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, from January 1, 2015 through December 31, 2019, Bluestone knowingly submitted claims for two E&M codes, the Nursing Home Home Visit for Established Patients code and the Care Management Code chronicles, which did not support the level. of service provided.

“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. »

As part of the settlement, Bluestone entered into a five-year corporate integrity agreement with the Department of Health and Human Services, Office of Inspector General, which requires Bluestone, among other obligations, to establish and maintaining a compliance program meeting certain requirements and subjecting Bluestone's Medicare claims to review by an independent review organization to determine whether such claims were medically necessary, properly documented and properly coded.

The civil settlement includes the resolution of claims filed under the qui tam or whistleblower provisions of the False Claims Act by Lisa Loscalzo, the 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 civil settlement also includes the resolution of related allegations investigated by the U.S. Attorney's Office for the District of Minnesota and 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).

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