EL PASO
El Paso Ear, Nose & Throat Associates (EPENT) has agreed to pay $750,000 to settle allegations that they violated the False Claims Act, officials announced Wednesday.
The violations occurred by billing Medicaid, Medicare and other federal healthcare programs by “upcoming” evaluation and management codes.
The government alleged that EPENT knowingly caused false claims to be submitted to federal healthcare programs by billing for services at a higher rate of reimbursement than they would be entitled to for the service actually provided.
This scheme is commonly referred to as “upcoding.”
“Providers who line their pockets by over-billing for medical care increase medical costs for all of us and drain critical funds from Medicare and other government health programs,” said U.S. Attorney Ashley C. Hoff.
The Defense Health Agency (DHA) supports the delivery of TRICARE, the program that provides integrated, affordable, high-quality healthcare services to more than 9.6 million uniformed service members, retirees and their families.
TRICARE was one of the government health programs that was defrauded in this case.
“Any time the government is defrauded, it is unacceptable to the American taxpayer. The victims in this case have served or continue to serve our Nation, and also includes their family members. We owe it to our beneficiaries that our commitment and care to them is unwavering, and we are grateful to the Department of Justice for their enduring commitment to root out waste, fraud and abuse and hold those who break the law accountable,” said DHA Director Lt. Gen. Ronald J. Place, M.D.