Healthcare Associates of Texas, an operator of eight clinics in North Texas and an affiliate of Optum, has been found guilty of filing more than 20,000 false Medicare claims, according to a Nov. 21 report from The Dallas Morning News.
The group could be facing up to $300 million fines. A Dallas-based law firm filed the suit on behalf of a whistleblower who discovered the alleged fraudulent claims when she worked in the clinics’ billing office.
"HCAT complied with applicable Medicare billing rules and continues to provide high-quality patient care. HCAT is disappointed in the verdict and will be pursuing all of its options," a lawyer for the health system told the publication.
The lawsuit alleges that the whistleblower, Cheryl Taylor, was fired after raising concerns about the false claims.
Healthcare Associates of Texas allegedly filed fraudulent Medicare claims in a number of ways, including by billing medical services under credentialed physicians when those services were actually rendered by subordinates and by misrepresenting the necessity of various lab panels and other screenings.
The practice also allegedly stretched annual wellness visits covered by Medicare into three separate billings, and tacked on excessive scans and lab work.
The fraud claims topped 47,000 between 2015 and 2021, according to the report.
A jury decided that not all of those claims had been fraudulent, but ruled that the practice knowingly submitted 21,844 fraudulent claims amounting to $2.8 million in damages to the government.Each individual fraudulent claim comes with a penalty that could range from about $14,000 to nearly $28,000, in accordance with the False Claims Act.
The jury also ruled that seven employees from the practice conspired to violate the False Claims Act.
Healthcare Associates of Texas could still appeal the ruling or settle the case with the plaintiff, according to the report.