NextCare Inc., a prominent operator of urgent care facilities across multiple states, has reached a settlement with the federal government and several states, agreeing to pay $10 million to resolve allegations of submitting false claims. This announcement, made by the Department of Justice, highlights the ongoing efforts to combat fraud within federal healthcare programs.
The allegations against NextCare center around claims submitted to Medicare, TRICARE, the Federal Employees Health Benefits Program, and Medicaid programs in Colorado, Virginia, Texas, North Carolina, and Arizona. Specifically, it was alleged that NextCare billed for allergy testing, H1N1 virus testing, and respiratory panel testing that were not medically necessary. Furthermore, the government contended that NextCare engaged in upcoding, a practice of inflating bills for urgent care medical services, during the period under investigation.
Stuart Delery, Acting Assistant Attorney General for the Civil Division, emphasized the significance of the settlement, stating, “This settlement demonstrates the Justice Department’s commitment to ensuring that federal health care dollars are spent appropriately. Health care providers who administer unnecessary services or who overcharge for care will be held accountable.”
U.S. Attorney Anne M. Tompkins for the Western District of North Carolina, echoed this sentiment, noting, “Today’s $10 million settlement with NextCare demonstrates our commitment to putting a stop to improper billing practices that exploit Medicare and drain vital resources from our health care system. NextCare’s upcoding and unnecessary medical testing wasted taxpayers’ dollars. This is a strong message to companies and individuals who engage in such conduct.”
Daniel R. Levinson, Inspector General of the Department of Health and Human Services (HHS-OIG), further commented on the implications for patient care, “Providers who subject beneficiaries to unnecessary medical testing, as alleged against NextCare, compromise the well-being of their patients and squander Federal health care funds.”
In addition to the financial settlement, NextCare Inc. will be subject to a five-year Corporate Integrity Agreement with HHS-OIG. This agreement mandates monitoring to ensure future compliance with federal healthcare program regulations, aiming to prevent similar issues from arising.
The case originated from a lawsuit filed by Lorin Cohen, a former NextCare employee, under the False Claims Act. This act allows private citizens to file lawsuits on behalf of the government against those who defraud federal programs. Ms. Cohen will receive $1.614 million as a reward for her role in bringing this information to light.
This settlement is part of the government’s broader Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, launched in 2009. HEAT represents a collaborative effort between the Department of Justice and HHS to combat healthcare fraud and protect taxpayer dollars. The Justice Department has recovered over $7.7 billion in cases involving fraud against federal health care programs since January 2009 through the False Claims Act alone, demonstrating the scale of this issue and the government’s dedication to addressing it.
The investigation and settlement were a joint effort involving multiple agencies, including the Civil Division of the Department of Justice, the U.S. Attorney’s Office for the Western District of North Carolina, the FBI, the North Carolina Attorney General’s Office, HHS-OIG, TRICARE Management Activity, and the Office of Personnel Management (OPM).
While the allegations have been settled, it is important to note that these are allegations, and there has been no formal determination of liability. The settlement represents an agreement to resolve the government’s claims.
