South Carolina's largest urgent care network and its management company will pay $22.5 million to resolve allegations that it violated the False Claims Act, the U.S. Justice Department said April 8.
According to prosecutors, Columbia-based Doctors Care and UCI Medical Affiliates of South Carolina falsely certified that certain urgent care visits were performed by providers credentialed to bill government insurers, but the services were performed by noncredentialed providers.
Insurance companies require providers to receive billing credentials and renew them periodically.
According to the whistleblower complaint, UCI was unable to secure and maintain the necessary billing credentials for most Doctors Care providers, but instead of resolving the problem or holding the claims until a solution was found, UCI submitted claims for services performed by the uncredentialed providers as if they had been provided by credentialed ones in order to get paid. The alleged scheme took place from 2013 to 2018.
Prosecutors said they had evidence such as emails and cheat sheets that UCI used to keep track of the providers that were properly credentialed. The U.S. Justice Department said there is no evidence that any Doctors Care provider worked without a medical license or that patient care was compromised.
In addition to agreeing to the settlement, UCI and Doctors Care signed a corporate integrity agreement requiring that UCI hire an independent review organization to perform claims reviews.
Under the settlement, UCI and Doctors Care admit no fault.