Total Access Urgent Care, a prominent urgent care chain with nearly 30 clinics in the St. Louis area, has agreed to a hefty $9.1 million settlement following allegations of submitting false claims to federal healthcare programs, including Medicare and TRICARE. The false claims allegedly indicated that nonphysician practitioners performed office visits when in fact a physician was the service provider.
The company allegedly submitted false insurance claims for COVID-19 testing and office visits. Additionally, some of these claims falsely signified that doctors were present during office visits when patients were actually seen by non-physician practitioners. Federal authorities stated that the company submitted these false claims to federal insurers to receive higher reimbursements. Furthermore, the company allegedly gave ‘productivity bonuses’ to doctors based on the volume of referrals for various health services, a practice that violates federal law.
In addition to the false claims, Total Access Urgent Care is accused of using improper billing codes, which resulted in reimbursements at an unjustifiably high rate. This includes upcoding office visit claims to receive higher reimbursement and overbilling the government for COVID-19 vaccines and treatments administered to uninsured individuals. Moreover, the company self-disclosed that bonuses paid to certain physicians were partly based on the...
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