In The News

TeamHealth Holdings Agrees to Pay $60 Million to Settle Medicare and Medicaid False Claims Act Allegations

When it comes to companies that are alleged to have defrauded the government, overbilling seems to be a recurring theme. This was shown to be the case when earlier this month, the Justice Department announced that hospital service provider, TeamHealth Holdings had agreed to resolve allegations that it violated the False Claims Act by billing Medicare, Medicaid, the Defense Health Agency and the Federal Employees Health Benefits Program for higher and more expensive levels of medical care than were actually performed. (This practice is known as “up-coding.”) Under the terms of a settlement agreement, TeamHealth will pay more than $60 million. “This settlement reflects our ongoing commitment to ensure that health care providers appropriately bill government programs vital to patient health care,” said acting Assistant Attorney General Chad A. Readler of the Justice Department’s Civil Division.


The government alleged that TeamHealth knowingly encouraged false billing by its hospitals. Specifically, the Justice Department charged that TeamHealth encouraged hospitals to bill for higher levels of service than were actually provided to their customers. These efforts to improperly maximize billing allegedly included pressure on hospitals with lower billing levels to match the billing levels of their peers. “When health care companies boost their profits by misrepresenting the services they bill to taxpayer-funded health care programs, our office will make sure they are held accountable for their deceptive schemes and that they make changes to bill these programs appropriately,” said Special Agent in Charge Lamont Pugh of HHS-OIG.


TeamHealth has also entered into a five-year Corporate Integrity Agreement (CIA) with the U.S. Department of Health and Human Services and Human Services Office of Inspector General (HHS-OIG). The CIA – which is a part of the $60 million settlement – is designed to improve the company’s accountability and transparency in order to avoid a repetition of these kinds of acts. “Medical providers who fraudulently seek payments to which they are not entitled will be held accountable,” said U.S. Attorney Zachary T. Fardon for the Northern District of Illinois. “False documentation of treatment is not just flawed patient care; it is illegal.”


The settlement came about as the result of a lawsuit that was filed by Dr. Bijan Oughatiyan, a physician formerly employed by TeamHealth as a hospitalist. The suit was filed under the qui tam, or whistleblower, provisions of the False Claims Act. This act permits private parties to sue on behalf of the government for false claims and to share in any recovery. Dr. Oughatiyan is scheduled to receive approximately $11.4 million. If you know of abuse that has been committed against the government or one of its agencies you are encouraged to report it and to contact a qui tam lawyer. A Qui tam attorney can advise you in such matters and will work to protect your rights under the law.