The U.S. Department of Justice announced on Tuesday that Physician Partners of America, along with its founder and former chief medical officer, have agreed to pay $24.5 million to resolve False Claims Act allegations.  

According to a DOJ press release, the medical group allegedly billed federal healthcare programs for unnecessary medical testing and services, including telemedicine; paid unlawful remuneration to its physician employees; and made a false statement in connection with a loan obtained through the Small Business Administration’s Paycheck Protection Program.   

"Billing federal healthcare programs for services that providers know are unnecessary or unreasonable undermines the quality of care that patients receive and increases the costs of these taxpayer-funded programs," said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division, in a statement.   

"The department is committed to ensuring that healthcare providers base their treatment decisions on their patients’ needs rather than their own financial interests," Boynton added.  

WHY IT MATTERS  

As outlined in the settlement agreement, PPOA is accused of using telemedicine during the COVID-19 pandemic to allegedly try and compensate for revenue lost from elective services.  

"During the global COVID-19 pandemic, Florida Governor Ron DeSantis ordered a pause on all nonemergency medical procedures effective March 20, 2020," said the DOJ in the agreement. "Shortly thereafter, PPOA instructed medical providers to begin seeing patients by telemedicine twice a month."  

"The increased number of [evaluation and management] telemedicine visits was designed to make up for lost revenue from the cancellation of elective interventional pain procedures," said the settlement agreement.

In addition, PPOA physicians allegedly scheduled appointments every two weeks regardless of patient need, resulting in increased billings and revenue for PPOA, according to the agreement.  

PPOA is also accused of allegedly submitting or causing the submission of false claims to Medicare by billing for qualitative and quantitative urine drug testing in violation of the physician self-referral law.  

"Specifically, the UDT was improperly referred by physicians who had direct or indirect compensation arrangements with PPOA that did not satisfy the requirements of any applicable exception to the Stark Law," said the agreement. 

"The physicians’ compensation was determined in a manner that took into account the value of the physicians’ referrals to and other business generated for PPOA," it continued.

The DOJ also alleges PPOA submitted other false claims regarding genetic testing, psychological testing and monitored anesthesia care.  

Due to the above allegations, the agency said PPOA falsely certified it was not engaged in "illegal activity" when it applied for a PPP loan.  

PPOA agreed to pay $24.5 million to the United States, which will distribute $8,786.20 to the state of Florida.   

It also entered into a five-year Corporate Integrity Agreement with the U.S. Department of Health and Human Services Office of Inspector General, under which it will undertake compliance efforts.  

"This Agreement is neither an admission of liability by PPOA nor a concession by the United States or the State of Florida that its claims are not wellfounded," according to the agreement. "PPOA denies the allegations in Paragraph II.E and the Civil Actions."  

THE LARGER TREND  

Concerns of fraud have dogged conversations around telehealth expansion beyond the public health emergency.  

In 2021, HHS OIG Principal Deputy Inspector General Christi A. Grimm said that oversight, transparency, accountability and program integrity are all the more important for virtual care amidst the COVID-19 pandemic.   

Later that year, the DOJ charged dozens in one of the biggest crackdowns to date, for a total of $1.1 billion.  

ON THE RECORD  

"Holding healthcare providers accountable for inflated claims and false statements helps ensure the integrity of the healthcare system as a whole," said U.S. Attorney Roger B. Handberg for the Middle District of Florida in a statement. "Settlements like this one are an important step in that direction."

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: kjercich@himss.org
Healthcare IT News is a HIMSS Media publication.