Nextcare pays $10 million to settle upcoding allegations

by Ben Vernia | July 3rd, 2012

On July 2, the Department of Justice announced that Nextcare, which provides urgent care services, had agreed to pay $10 million to resolve False Claims Act allegations that it submitted “upcoded” claims to federal healthcare programs. According to DOJ’s press release:

NextCare Inc., an Arizona-based company, has agreed to pay $10 million to settle federal and state allegations that it submitted false claims, the Justice Department announced today. NextCare is an owner of a chain of urgent care facilities with locations in Arizona, Colorado, Texas, North Carolina, Ohio and Virginia.

The settlement resolves allegations that NextCare submitted false claims to Medicare, TRICARE and the Federal Employees Health Benefits Program, as well as the Medicaid programs of Colorado, Virginia, Texas, North Carolina and Arizona, by billing for unnecessary allergy, H1N1 virus and respiratory panel testing. The United States also alleged that NextCare inflated billings for urgent care medical services in the years under review, a practice known as upcoding.

The suit was originally brought by a qui tam whistleblower, who the Government announced will receive $1.614 million from the settlement (approximately a 16% relator’s share).

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