California Billing Company Ponies Up $4.6M to Settle False Claims Allegations

California-based medical billing company Janzen, Johnston & Rockwell Emergency Medicine Management Services Inc. (JJ&R) has agreed to pay $4.6 million to settle allegations that it submitted false claims to Medicare and Louisiana’s Medicaid program, according to the Department of Justice (DOJ).

The settlement arose from allegations that JJ&R inflated claims that it had coded on behalf of emergency room (ER) physicians in Louisiana and California. For nearly seven years (2000-2007), the DOJ said, JJ&R employed a coding formula that tended to upcode evaluation and management (E/M) services. JJ&R also routinely added charges to E/M claims for minor services, such as pulse oximetry, that had been provided by hospital nursing staff or other physicians. JJ&R often failed to comply with Medicare’s coding rules governing the submission of claims for teaching physicians, as well.

A whistleblower and former JJ&R employee initiated the charges against JJ&R under the False Claims Act, and will receive $774,450 for her role in recovering the money for the government.

“In Louisiana’s Middle District, we are committed to using all available tools, including affirmative civil actions, to combat health care fraud,” commented Donald J. Cazayoux Jr., U.S. Attorney for the Middle District of Alabama.

Tony West, assistant attorney general for the Civil Division of the DOJ, also weighed in: “Inflating individual health care claims by even small amounts can cause significant losses to Medicare and Medicaid. Taxpayers should not be on the hook for charges that shouldn’t have been added or claims that shouldn’t have been submitted.”

The Department of Health & Human Services (HHS) Office of the Inspector General and the Commercial Litigation Branch – Fraud Section of the Justice Department’s Civil Division also participated in the investigation.

In recent years, the government has ramped up its efforts to combat health fraud, which has included programs such as the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative. Also instrumental is the False Claims Act, which the DOJ says it has used to recover more than $5.9 billion since January 2009 in cases involving fraud against federal health care programs.

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