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 by billing Medicaid, Medicare and other federal healthcare programs by upcoding 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. “We will continue to hold accountable medical professionals who undermine our healthcare system by over-billing for care.”
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.
“Unethical medical 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 Acting Special Agent in Charge Jeffrey Coburn. “The FBI will continue to hold accountable medical professionals who undermine our healthcare system through fraudulent over-billing for care.”
The matter was investigated by the FBI, U.S. Department of Health and Human Services Office of Inspector General, Defense Criminal Investigative Service and the Texas Attorney General’s Office Civil Medicaid Fraud Division.
The claims asserted against the defendants are allegations only; there has been no determination of liability.
Assistant U.S. Attorney Eduardo R. Castillo handled this matter.