An Oklahoma City company that does billing for hundreds of hospital emergency room physicians may be hit with a U.S. Justice Department lawsuit accusing it of filing false reimbursement claims.
This is the second action in two months illustrating the Justice Department's apparent crackdown on billing in hospital emergency departments.
Last week, Dallas-based EmCare Holdings disclosed that Emergency Physicians Billing Services, which handles about one-third of its billings, may be sued by the Justice Department. Although EmCare said it won't be named in the suit, the Justice Department has said it may recoup possible overpayments made to EmCare as a result of the billing company's services.
Officials of the Oklahoma City company, also known as Medical Consultants, could not be reached for comment. However, the company reportedly bills for other emergency department physicians and contract-management firms.
Of EmCare's $150 million in projected 1995 revenues, about $22.5 million would be government reimbursements billed through Emergency Physicians, said EmCare's chairman and chief executive officer, Leonard Riggs, M.D. EmCare continues to do business with Emergency Physicians but is conducting its own investigation, he said.
Emergency Physicians has denied wrongdoing. EmCare officials said Emergency Physicians also has agreed to be responsible for billing errors.
The Justice Department action stems from a "whistleblower" lawsuit filed last year against Emergency Physicians concerning "upcoding" by the company. Upcoding involves maximizing a provider's reimbursement by coding a medical procedure at a higher payment rate. The Justice Department is now considering becoming a plaintiff in the whistleblower suit, officials said.
The Oklahoma City firm had been in merger discussions with another billing company, Atlanta-based Medaphis Corp. Those discussions were suspended last month because of the Emergency Physicians whistleblower suit.
Some Medaphis operations also have been targeted by the federal government. Last month, two of the company's offices in California were searched by federal agents for billing and collections documents (June 26, p. 30).