CityMD to settle COVID fraud claims for $12M (updated) - NJBIZ
Listen to this articleThe Justice Department announced June 7 it reached a $12.04 million settlement with CityMD. The health care provider manages and operates more than 175 urgent care practices in New Jersey and New York.
The agreement resolves allegations that the company violated the False Claims Act by submitting or causing the submission of false claims for payment for COVID-19 testing to a Health Resources & Services Administration (HRSA) program for uninsured patients. During the pandemic, that program provided claims reimbursement to health care providers – generally at Medicare rates – for testing, treating and administering vaccines to uninsured individuals.
From Feb. 4, 2020, through April 5, 2022, the Justice Department alleged that CityMD knowingly submitted or caused to be submitted false claims for payment for COVID-19 testing to the Uninsured Program.
"The United States contends that CityMD did not adequately confirm whether those individuals had health insurance coverage before submitting their claims to the Uninsured Program, including but not limited to certain individuals for whom CityMD had health insurance cards on file," the United States Attorney's Office for New Jersey wrote in a press release announcing the settlement. "The Justice Department further contends that CityMD caused outside laboratories to submit false claims for COVID-19 testing to the Uninsured Program in connection with individuals who had health insurance coverage by issuing requisition forms erroneously indicating that patients were uninsured."
'We remained open'
In a June 12 statement to NJBIZ, CityMD noted that the settlement is not a finding of liability nor an admission of wrongdoing – and that the company denies the allegations but settled to avoid the cost and burden of prolonged litigation.
"CityMD is proud of the health care services we provided to patients throughout the pandemic. When many medical practices were closed during the lockdown, we remained open and available to patients," CityMD told NJBIZ. "Our dedicated team members bravely came to our locations and, despite all of the unknown, supported and cared for our patients in extremely challenging times. For that, we are so thankful to our physicians, providers and staff."
CityMD said it remains proud about being available to patients at all times throughout the pandemic.
"And we look forward to continuing to serve them," CityMD stated. "We will always remain committed to our patients and our employees as our top priority."
Credit due
Under the settlement, the Justice Department credited CityMD for taking voluntary disclosure, cooperation and remediation into account in False Claims Act cases.
"CityMD cooperated with the United States' investigation by, among other things, voluntarily contracting with a third-party to assist the United States in determining the amount of the losses the United States contends were caused by claims submitted by CityMD to the Uninsured Program for patients who had health insurance as described above," the Justice Department stated.
The settlement also includes a resolution of claims brought by a whistleblower. Steven Kitzinger, a patient of CityMD, will receive $2.05 million as his share of the recovery.
"Uninsured Americans who were at risk from COVID-19 were covered by emergency funding programs that made available to them the testing, vaccines, and treatments that they needed," said U.S. Attorney for New Jersey Philip Sellinger. "The alleged misuse of these funds is something we cannot and will not tolerate. Today's settlement ensures that the money that was obtained inappropriately will be returned to the government."
VillageMD closed its $8.9 billion acquisition of Summit Health-CityMD Jan. 6, 2023. Summit Health and CityMD previously merged in August 2019.
Editor's note: This story was updated at 8:18 p.m. ET June 12, 2024, to include a statement from CityMD.
Comments
Post a Comment