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Jacksonville, FL-based Gottlieb’s Financial Services, Inc. (GFS) and its parent company, Medaphis Physician Services Corporation of Atlanta, have agreed to pay the federal government and 35 fives states $15 million to settle charges that GFS submitted false claims to various federal health care programs, including Medicare, Medicaid, and TRICARE, as well as the Federal Employees Benefits program.
The U.S. Attorney’s Office for the Western District of Michigan, which brokered the settlement, alleges that GFS submitted false claims to the health care programs on behalf of emergency department physicians and emergency room staffing companies around the country. According to the U.S. Attorney’s Office, GFS used computer software to systematically upcode claims and billed for services to make it appear that more extensive services were rendered than were actually provided by the physicians.
Although staff members were required to identify and input data into the computer software system, the program itself automatically assigned CPT-4 codes, regardless of the documentation of physician services present in the chart, according to the official complaint.
A spokesman for the U.S. Attorney’s office declined to say how many emergency physicians may have been involved in the scheme, or whether charges are pending against them.
The agreement settles a dispute with GFS and Medaphis originally brought as a qui tam case in U.S. District Court in Grand Rapids, MI. The whistleblower, Greg Robinson, who was a vice president with GFS in the mid-1990s, will receive $2.4 million in the settlement. He remains under contract with GFS as a consultant.