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Doctors Care, SC medical groups to pay $22.5M in medical fraud case – Florence, South Carolina

Florence, South Carolina 2021-04-08 10:00:22 –

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Columbia, South Carolina (WCBD) – Doctor’s Care and the South Carolina medical group will pay $ 22.5 million to settle a civil lawsuit for health fraud.

This is TRICARE for Medicaid, Medicare, and medical services by Doctor’s Care, the state’s largest network of emergency healthcare providers, and its management company, UCI Medical Affiliates, South Carolina.

Instead, the proceedings state that the service was carried out by an unqualified provider.

According to M. Rhett DeHart, Deputy Federal Attorney for South Carolina, federal health insurance companies are asking doctors and mid-career providers to apply for and approve their services to claim their services. He said this approval is known as the provider’s “billing credentials.”

Providers are obliged to update these billing credentials on a regular basis and will need to obtain new credentials for new employment.

According to a news release provided by DeHart’s office, the proceedings allege that the UCI failed to protect and maintain the billing credentials required by most DoctorsCare providers dating back to 2013.

The UCI also stated that it knew that the federal insurance program would reject claims sent with a provider’s claim number that had not yet received claim credentials. “But instead of resolving the credential problem or holding the claim until a temporary solution is found, UCI incorrectly filed the claim and linked the uncredited rendering provider to the credential billing provider. “I paid the complaint,” the DeHart office reported. ..

For each “linked” invoice, it is alleged that the UCI deliberately filed a false claim. Evidence supporting the allegations includes an email commemorating the UCI’s “link” scheme and a well-organized “cheat sheet.” It was used by the UCI to track properly qualified billing providers who can replace their names with unqualified providers. Bills.

The “claim eligibility” in question in this case is different from the provider’s degree or license to practice medical care. In this case, there is no evidence that the doctor care provider did not have a doctor’s license or that the patient’s care was compromised due to the act in question.

“When a healthcare company deals with the federal government, it has to follow the rules like everyone else,” De Hart said. “All companies of this distinction, regardless of size, must respect their commitment to provide competent care in the full text of the law. Our offices continue to protect taxes and the rule of law I will protect you. “

“Taxpayers and Medicare patients naturally expect healthcare providers to qualify properly before charging for services,” said a special agent in charge of the US Department of Health and Human Services’ Inspectorate. Derrick L. Jackson said. “). “We will continue to work with law enforcement partners to protect the federal healthcare program.”

The $ 22.5 million settlement came after more than three years of investigation led by the US Federal Attorney’s Office in collaboration with HHS-OIG and DCIS.

Doctors Care, SC medical groups to pay $22.5M in medical fraud case Source link Doctors Care, SC medical groups to pay $22.5M in medical fraud case

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