A multistate chronic disease management provider has agreed to pay $14.9 million to resolve claims it knowingly submitted claims that were not provided in conformity with Medicare, Medicaid and Tricare requirements.
From Jan. 1, 2015, to Dec. 31, 2019, Bluestone Physician Services of Florida, Bluestone Physician Services and Bluestone National — which operate in Florida, Minnesota and Wisconsin, respectively — allegedly submitted claims for two codes that did not support the level of service provided, according to a June 5 news release from the Justice Department.
The codes included the domiciliary rest home visit code for established patients and the chronic care management code. The suit was brought by Lisa Loscalzo, the former general manager for Bluestone’s Florida market, under the whistleblower provisions of the False Claims Act.
The federal government will receive roughly $13.8 million, and $1.1 million will be paid to Florida and Minnesota.
"Bluestone’s highest priority is providing excellent care to our patients, who are among our nation’s most vulnerable, and we take compliance with all laws and regulations governing our industry very seriously," a spokesperson for Bluestone said in a statement shared with Becker's. "Nothing about this matter relates to the efficacy of the healthcare we provide, which has improved our patients’ care outcomes and has not been called into question. Rather, the allegations relate to medical record documentation issues that occurred under prior management between 2015 and 2019. While we deny the allegations, we have agreed to this settlement so we can focus exclusively on bringing effective, high-quality care to the fragile and medically complex patients who rely on us."