Total Access Urgent Care (TAUC), a healthcare provider, has agreed to a significant settlement of $9,150,794 with the U.S. Attorney’s Office for the Eastern District of Missouri. This agreement resolves allegations that TAUC submitted false claims for medical services to federal healthcare programs, including claims related to COVID-19 testing. The announcement was made by U.S. Attorney Sayler A. Fleming, highlighting the commitment to recovering funds from overbilling and fraudulent activities within the healthcare system.
The core of the allegations against Total Access Urgent Care involves multiple instances of improper billing practices spanning several years. According to the U.S. Attorney’s Office, from April 2017 to November 2021, TAUC allegedly submitted claims to Medicare and TRICARE falsely indicating that physician services were provided when, in fact, a non-physician practitioner had performed the office visits. This practice, known as “upcoding,” allowed TAUC to receive higher reimbursement rates than they were entitled to.
Furthermore, the government contended that from November 2015 to November 2021, Total Access Urgent Care engaged in systematically upcoding claims for office visits submitted to Medicare and TRICARE. This means they billed for more complex and expensive service codes than were actually warranted by the services rendered. The scope of this upcoding extended to claims submitted to the Health Resources and Services Administration’s COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured Program (UIP). This program was designed to reimburse providers for COVID-19 related services for uninsured individuals. The allegations suggest that even within this specific COVID-19 relief program, Total Access Urgent Care continued its practice of inflating billing codes.
Adding to these allegations, Total Access Urgent Care itself disclosed during the investigation that between April 1, 2021, and December 31, 2021, it submitted incorrect claims to Medicare, TRICARE, and the UIP for COVID-19 testing. Specifically, it was revealed that they used improper billing codes for COVID tests, which again resulted in inflated reimbursements from these federal healthcare programs. These cumulative actions, as alleged by the government, led to Total Access Urgent Care receiving reimbursements from federal healthcare programs to which they were not rightfully entitled.
Despite the settlement, it is important to note that Total Access Urgent Care cooperated fully throughout the investigation and, as part of the agreement, did not admit liability. The settlement also addressed a self-disclosure made by TAUC in March 2021 to the Centers for Medicare & Medicaid Services. This disclosure concerned bonuses paid to certain physicians that were, in part, based on the volume or value of their referrals for designated health services, which is a prohibited practice under federal law designed to prevent conflicts of interest and ensure patient care decisions are not influenced by financial incentives.
Curt L. Muller, Acting Special Agent from the U.S. Department of Health and Human Services Office of Inspector General, stated, “Today’s outcome illustrates HHS-OIG’s unwavering commitment to detecting, investigating, and shutting down fraud against Medicare, the HRSA Uninsured Program and protecting federal health care programs under any circumstance — especially during a public health emergency.” He emphasized the ongoing vigilance against healthcare fraud, particularly schemes involving fraudulent claims.
Gregory P. Shilling, Acting Special Agent-in-Charge of the Department of Defense Office of Inspector General’s Defense Criminal Investigative Service (DOD-OIG-DCIS), also commented on the case. He stated, “When actors within our healthcare system are focused on profit rather than patient care, it undermines the integrity of the medical decision-making process.” Shilling reinforced the commitment of DCIS to protecting the financial integrity of the Defense Health Agency, which serves military personnel and their families.
This settlement is part of a broader effort by the Department of Justice and the U.S. Department of Health and Human Services to recover funds lost to fraud within federal healthcare programs like Medicare. The investigation and settlement were a collaborative effort involving the U.S. Attorney’s Office for the Eastern District of Missouri, HHS-OIG, DOD-OIG-DCIS, and the FBI, demonstrating a united front against healthcare fraud and ensuring accountability within the system.
