The Columbia-based urgent-care chain Doctors Care and its management company have agreed to pay $22.5 million to settle allegations they defrauded three government health insurance programs.
The U.S. Attorney's Office announced the charges against Doctors Care, a quick clinic company headquartered in Columbia with 50 locations throughout the state, and its management company, UCI Medical Affiliates of South Carolina, on April 8.
Following a whistleblower complaint, government investigators found the two companies were submitting falsified claims to Medicare, Medicaid and Tricare, which is the military's health insurance program, between 2013 and 2018.
The government-run insurers require providers that submit payment claims to have certain credentials. But Doctors Care and UCI allegedly sent in claims for urgent care visits that weren't conducted by credentialed providers, instead substituting the name of other providers with the proper credentials.
The companies even used "cheat sheets" to keep track of whose name to put on a claim, according to prosecutors.
“When health care companies do business with the federal government, they must follow the rules like everyone else,” M. Rhett DeHart, acting U.S. Attorney for South Carolina, said in a statement.
"All companies with this distinction — regardless of size — should honor their commitment to provide competent care to the full letter of the law," he added. "Our office will continue to protect tax dollars and ensure the rule of law is followed."
An investigation has been ongoing for three years. Lawyers for the government said patients and the quality of their health care were never at risk because of the alleged fraud, and that Doctors Care and UCI management worked quickly to stop the practice after receiving a first subpoena in 2018.
The companies did not admit fault in settling the case, Jill Armbruster, a spokeswoman for Doctors Care and UCI, said in a statement.
"The government did not accuse Doctors Care of providing unnecessary or low-quality services, or of billing for services that were not rendered," she said. "At all times, Doctors Care utilized qualified clinicians and provided a high standard of care to its patients, just as it does today."
She added the current management at Doctors Care and UCI were "unaware of, and were not involved with" any of the conduct that led to the government's investigation. UCI announced a "new executive leadership team" in early 2019, not long after it became aware of the government's allegations.
Doctors Care and UCI also committed to a "corporate integrity agreement" that will provide government oversight over their operations for the next five years.
According to court documents, UCI is majority-owned by BlueCross BlueShield of South Carolina, the state's largest private insurer. The Columbia-based company was not named as a defendant, and it had no comment on the settlement, a spokeswoman said April 8.
The two whistleblowers both worked for UCI — one as a medical biller and the other as a health care management specialist. They will receive more than $5.4 million for bringing the allegations to the government's attention, according to the settlement agreement.
Bert Louthian, Bill Nettles, Fran Trapp and John Simmons, all attorneys based in Columbia, represented the pair of whistleblowers.
Louthian said the billing credentials at the heart of the case against Doctors Care are an important mechanism the government uses to check providers' licenses "to make sure that patient care is at the highest level possible and that patients are safe."
Fraud in the Medicare, Tricare and Medicaid programs is a major source of government waste. In the 2016 fiscal year, for instance, federal prosecutors identified hundreds of such cases and won settlements or judgments totaling $2.5 billion, according to the U.S. Government Accountability Office.
"It's an honor and a privilege to be able to represent these brave whistleblowers who come forward with information concerning fraud on behalf of the American taxpayers," Louthian said.
Passerby might also notice the Medical University of South Carolina's label on some Doctors Care signs. The two organizations forged a clinical partnership beginning in 2015, but the entities don't exchange money as part of it, a spokeswoman for MUSC said.
The spokeswoman said MUSC "remains committed to its relationship with Doctors Care" and declined to comment further.