Upcoding is at the core of a Medicare fraud whistleblower suit filed against IPC The Hospitalist Company in federal court in Chicago. The whistleblower, a doctor formerly employed by the company, makes these key allegations in the complaint:

  • IPC trains and encourages its doctors to upcode. IPC's training can be seen by comparing the billing records of IPC doctors when they first joined IPC with the billing records of those same IPC doctors after they have received IPC's training and become assimilated into IPC's fraudulent culture.
  • IPC doctors disproportionately billed at the highest level billing codes established by government insurers. Of records reviewed a bill was submitted with the highest of three possible billing levels 94% of the time.
  • IPC doctors regularly submitted daily billing records for services that would have taken in excess of 24 hours to perform, even using extremely conservative estimates.
  • IPC's upcoding scheme causes IPC doctors to increase the number of patients they treat in one day and, therefore, decrease the amount of time they spend with each patient, jeopardizing patient care. Indeed, at least one IPC doctor submitted a billing records for treating 65 patients in a single day.

The case is United States ex rel Oughatiyan v. IPC The Hospitalist Co., 09-cv-5418, U.S. District Court, Northern District of Illinois(Chicago); review here a copy of the complaint.

The whistleblower lawsuit was filed under the federal False Claims Act.  These lawsuits are sometimes referred to as a "qui tam action." This case highlights some of the problems that can arise in the compensation, productivity and bonus schemes of some doctors groups and/or hospitals; incentives if not imperatives to up code and inflate productivity can be present. The United States Department of Justice has elected to intervene in this lawsuit on behalf of of the whistleblower reports the Bloomberg News.

Lexington, Kentucky whistleblower lawyer Robert Abell represents individuals and employees in Medicare fraud and Medicaid fraud whistleblower cases under the False Claims Act; you can reach him at 859-254-7076.



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