Tampa, Fla.-based Physician Partners of America will pay $24.5 million to settle several allegations, including that it violated the False Claims Act and made a false statement to obtain a loan through the Small Business Administration’s Paycheck Protection Program.
Four whistleblower lawsuits were filed against the healthcare practice management company the U.S. Justice Department said April 12.
The first whistleblower complaint was filed in 2018, alleging the pain management clinics engaged in Medicare billing fraud and paid kickbacks to physicians for referrals.
Physician Partners of America is accused of requiring its staff to order the most expensive urine drug tests for every patient, regardless of whether they were medically necessary. The organization allegedly benefited greatly financially because it sent the tests to the two clinical labs it owes.
Physician Partners incentivized its physician employees to order the additional tests by paying them 40 percent of the profits, a violation of Stark Law,the Justice Department said.
The Justice Department alleges Physician Partners also required patients to submit to genetic and psychological testing before they were seen by physicians, without determining whether the testing was necessary, and then billed federal healthcare programs for the tests.
When Florida suspended all nonemergency medical procedures in March 2020, the organization allegedly required physicians to schedule unnecessary evaluation and management appointments with patients and instructed them to bill for those visits using inappropriate high-level procedure codes, according to the Justice Department.
Physician Partners is also charged with falsely claiming it was not engaged in overbilling in order to get a $5.9 million Paycheck Protection Program loan.
As part of the settlement, Physician Partners of America entered into a five-year corporate integrity agreement with the HHS Office of Inspector General and must undertake significant compliance efforts, according to the Justice Department.