Feds Sue IPC For Upcoding Claims

The federal government has joined a lawsuit against IPC The Hospitalist Co. that accused the North Hollywood firm of systematically upcoding charges for patient care submitted to the Medicare program.

The U.S. Attorney's office in Northern Illinois announced earlier this week it was joining the qui tam, or whistleblower, suit filed five years ago by a Dallas physician formerly employed by the firm. It was originally filed in federal court under seal in Chicago. 

The U.S. Attorney's office had been investigating the case itself for several years. The Chicago office has been very aggressively pursuing both civil and criminal cases for healthcare fraud in recent years.

Bijan Oughatiyan, M.D., had worked for IPC between 2003 and 2008. The suit claims that IPC had billed the Medicare and Medicaid programs at the highest price levels more than 90% of the time. The suit also claims that IPC's physician staff was systematically pressured to bill accordingly, a practice known as upcoding. Physicians who went along recieved higher profit sharing checks from the publicly-traded company, the lawsuit alleged.

In its suit, the federal government alleges that IPC's charges for hospitalist services are far higher than the national average.

In a statement, IPC said it believes “it has a strong compliance focus, and that it operates with appropriate billing policies, procedures, provider training, and compliance programs and controls

Typically, once the federal government intervenes in a whistleblower suit, the defendant company will try and settle the litigation. Under federal law, Oughatiyan could be entitled to up to 15% of the settlement, which could run into the tens of millions of dollars.

IPC said it “continues to work expeditiously toward a resolution with the Department of Justice.”