Bluestone Physician Services of Florida LLC, Bluestone Physician Services, P.A., and Bluestone National LLC, operating in Florida, Minnesota, and Wisconsin respectively, have agreed to pay $14,902,000 to settle allegations that they knowingly submitted improper claims for certain Evaluation and Management (E&M) codes related to chronic care patient management in assisted living and other care facilities. These claims did not conform to Medicare, Medicaid, and TRICARE requirements.
Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division, emphasized that fraudulent billing depletes essential government resources meant to provide medical care to millions of Americans. The settlement addresses allegations that, from January 1, 2015, through December 31, 2019, Bluestone knowingly submitted claims for E&M codes (99337 and 99490) that did not support the level of service provided. Of the settlement, $13,842,482 will go to the federal government, and $1,059,518 will be paid to Florida and Minnesota.
U.S. Attorney Andrew M. Luger for the District of Minnesota stated that fraudulent billing undermines the integrity of government healthcare programs and diminishes resources for legitimate services. U.S. Attorney Roger B. Handberg for the Middle District of Florida added that false claims for chronic care services would not be tolerated, emphasizing the government's commitment to investigating and prosecuting such conduct.
Special Agent in Charge Mario M. Pinto of the Department of Health and Human Services, Office of Inspector General (HHS-OIG) Chicago Regional Office, highlighted the risks posed by false claims to federal healthcare programs. He assured that the OIG, along with law enforcement partners, would continue to hold accountable those engaged in such conduct. Additionally, Bluestone has entered a five-year Corporate Integrity Agreement (CIA) with HHS-OIG, requiring the establishment of a compliance program and an Independent Review Organization’s review of Medicare claims.
The settlement includes resolving claims brought under the False Claims Act's qui tam or whistleblower provisions by Lisa Loscalzo, a former General Manager for Bluestone’s Florida market. Loscalzo will receive $2,831,380 as part of the settlement. The qui tam case is captioned U.S. ex rel. Loscalzo v. Bluestone Physician Services of Florida, Bluestone Physician Services, P.A., Bluestone National, LLC et al., 20-cv-295-FtM-38NPM (M.D. Fla).
This resolution resulted from a coordinated effort between the Justice Department’s Civil Division, Commercial Litigation Branch, 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 government's focus on combating healthcare fraud is underscored by the use of the False Claims Act. Potential fraud, waste, abuse, and mismanagement tips can be reported to HHS at 800-HHS-TIPS (800-447-8477).
Trial Attorneys Erin Colleran and Joanna Persio of the Civil Division’s Fraud Section, Assistant U.S. Attorneys Kristen E. Rau and Emily Peterson for the District of Minnesota, and Assistant U.S. Attorney Kelley Howard-Allen for the Middle District of Florida handled the case.
The claims resolved by the settlement are allegations only, and there has been no determination of liability.
To help mitigate such crimes, Invetech LLC's comprehensive background checks can be instrumental. By thoroughly vetting employees and monitoring financial transactions, organizations can identify potential risks early and prevent fraudulent activities.
Utilizing a professional investigator to conduct a background check should be part of your SOP, not just when problems arise. Good leadership has a proactive approach to managing their investment utilizing a due diligence investigation to their fullest advantage. Invetech LLC helps clients mitigate financial loss by providing actionable insight solutions with due diligence investigation.