Investigations Newsletter: Urgent Care Provider and Management Company to pay $22.5 Million to End FCA Claims

Arent Fox

Headlines that Matter for Companies and Executives in Regulated Industries.

Litigation Developments

Urgent Care Provider and Management Company to pay $22.5 Million to End FCA Claims

South Carolina urgent care providers agreed to pay $22.5 million to resolve False Claims Act claims filed by two former employees. The whistleblowers claimed that Doctors Care P.A. (Doctors Care), its management company, UCI Medical Affiliates of South Carolina, Inc. (UCI), and a related holding company, UCI Medical Affiliates, Inc., falsely certified that certain providers were approved to bill to Medicaid, Medicare, and TRICARE for medical services when the services were actually performed by non-credentialed physicians and other providers. The claims were only related to billing credentials, which are not related to the providers’ licenses to practice medicine.

Physicians and certain other providers are required to apply for and receive approval, known as “billing credentials,” to bill services to federal health insurance companies. Providers must periodically renew these credentials and obtain new credentials with changed employment. The whistleblowers alleged that UCI could not secure and maintain the billing credentials for most providers at Doctors Care. Knowing the federal insurance programs would deny its claims if they were submitted with the billing number of a provider without the necessary credentials, UCI allegedly submitted false claims linking the uncredentialed providers to credentialed billing providers.

The Department of Justice (the DOJ) noted that the settlement is the result of more than three years of investigation and that UCI and Doctors Care acted quickly to investigate and stop the conduct upon receiving the first investigative subpoena in 2018. In addition to the $22.5 million payment, Doctors Care and UCI entered into a Corporate Integrity Agreement for a five-year period. As part of the deal, the whistleblowers will receive $5.4 million of the $22.5 million payment in addition to $2.1 million for costs, legal fees, and expenses.

Additional details are included in the DOJ’s press release and at Law360.

SEC Developments

Three Men Indicted for Foreign Exchange Fraud Scheme

Last week, a federal grand jury in the Southern District of Florida returned an indictment charging three men with devising a $30 million foreign exchange trading scheme. The defendants allegedly solicited the victims to invest in Global Forex Management, their foreign exchange company, by promising large returns based on invented prior trading results. The alleged victims were told that their funds would be traded using an online platform provided by one of the defendant’s companies, IB Capital.

According to the indictment, the defendants allegedly stole $30 million from the investors by fabricating trading losses while they were actually routing the money through shell companies set up across the world. The defendants were charged with conspiracy to commit securities fraud, securities fraud, conspiracy to commit wire fraud, and conspiracy to commit money laundering. The defendants face a maximum penalty of five years in prison for the conspiracy charges and up to 20 years in prison for each additional charge.

Read more in the DOJ’s press release.

[View source.]

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