by Ben Vernia | September 2nd, 2011
On September 1, the Department of Justice announced that an El Segundo, California, medical billing firm has agreed to settle claims originally brought by a qui tam whistleblower. According to DOJ’s press release:
Janzen, Johnston & Rockwell Emergency Medicine Management Services Inc. (JJ&R), a provider of billing services for physicians, hospitals and other health care providers, has agreed to pay the United States $4.6 million to settle allegations that it submitted false claims to Medicare and Louisiana’s Medicaid program, the Justice Department announced today. JJ&R is headquartered in El Segundo, Calif.
Today’s settlement resolves allegations that JJ&R inflated claims that it had coded on behalf of emergency room physicians in Louisiana and California. From approximately 2000 through 2007, JJ&R utilized a coding formula that had a tendency to generate claims for a marginally higher level of evaluation and management service than the physicians had actually provided. In addition, JJ&R routinely added charges to the evaluation and management claim for minor services, such as pulse oximetry, that had been provided by hospital nursing staff or other physicians.
Finally, during this time period, JJ&R often failed to comply with Medicare’s coding rules governing the submission of claims for teaching physicians, resulting in the submission of claims that were not properly payable. While these coding practices had a relatively small impact on the reimbursement of any particular claim, over time they generated significant overpayments from Medicare and Medicaid.
The government announced that the whistleblower will receive $774,450 (a 16% relator’s share).
