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EMERGENCY PHYSICIAN GROUPS TO PAY U.S. AND STATES

WASHINGTON, D.C. -- Four emergency physician groups are paying the United States and various states more than $2.6 million to settle allegations that the groups received overpayments based on false claims submitted by their billing company, the Justice Department announced today. Today's settlement resolves allegations that the groups overcharged Medicare, Medicaid, and the Defense Department's TRICARE program, as well as the Federal Employees Health Benefits Program (FEHBP).

Emergency Physicians Medical Group, P.C., MBLS Emergency Physicians, P.A., Western Emergency Physicians and Sierra Emergency Physicians, Inc., hired Emergency Physicians Billing Services (EPBS), an Oklahoma City billing company, to submit claims on their behalf to federal and state health care programs. EPBS then submitted false Medicare, Medicaid, TRICARE, and FEHBP claims for patients seen by the groups' physicians. The United States alleged that EPBS typically upcoded claims and billed for services more extensive than those actually provided by the groups' physicians.

"This settlement again demonstrates the United States' commitment to protecting federal funds from fraud and abuse," said David W. Ogden, Assistant Attorney General in charge of the Civil Division. "The federal health care system operates on the good faith and honesty of its providers, and we cannot tolerate misuse of the reimbursement system for financial gain."

Emergency Physicians Medical Group, P.C., which operates in Michigan, Pennsylvania and Ohio, is paying $2,350,000 in settlement while MBLS Emergency Physicians, P.A., a Florida group, is paying $87,000. Western Emergency Physicians of Utah is paying $87,000 and Nevada-based Sierra Emergency Physicians, Inc. is paying $79,158.

The agreement settles a dispute with the groups originally brought as a qui tam or whistleblower case in the United States District Court in Oklahoma City. As part of the settlement, the estate of Theresa Semtner, who filed the suit on behalf of the United States, will receive approximately $443,502. Ms. Semtner was a former employee of EPBS. These settlements are the latest in a series of settlements with other EPBS clients. The United States settled with EPBS in October 1999, but is continuing to pursue recoveries against other EPBS clients.

The case was conducted by the Civil Division and the U.S. Attorney's Office for the Western District of Oklahoma, with the assistance of HHS' Offices of Inspector General in Washington, D.C., and Dallas, Texas; the Oklahoma City office of the FBI; the Tulsa Resident Agency of the Defense Criminal Investigative Service; the Program Integrity Branch of the TRICARE Program, the United States Department of Defense; the Office of Inspector General for the Office of Personnel Management in Washington, D.C.; and various State Attorney General Medicaid Fraud Control Units around the country. Additional audit support was provided by Xact, the Medicare intermediary in Pennsylvania, and the Mailhandlers Plan of the FEHBP.

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