Federal prosecutors say the New York City-based urgent care chain admitted that it charged Medicare for more expensive procedures, and billed the federal government for services provided by uncredentialed physicians.
CityMD, a chain of 88 urgent care centers in the New York City area, will pay $6.6 million to settle False Claims Act allegations brought forward in a whistleblower lawsuit, the Department of Justice announced.
Federal prosecutors in New York said that CityMD billed Medicare for services that physicians did not perform, and billed Medicare for more expensive and complex services than were actually provided to patients.
CityMD admitted and accepted responsibility for its conduct in U.S. District Court in Manhattan this week, and agreed to pay $6,606,251.40 in damages, DOJ said, adding that the urgent care company "cooperated fully with this investigation."
"CityMD improperly billed Medicare at significant cost to taxpayers," Manhattan U.S. Attorney Geoffrey S. Berman said. "This settlement holds CityMD accountable both through the significant monetary payment and the detailed admissions made by CityMD."
As part of the settlement, CityMD admitted responsibility for the following conduct:
- CityMD billed Medicare for lengthier and/or more complex services or procedures than the services or procedures it actually provided to patients or that were supported with documentation in the medical records.
- CityMD employed a number of physicians who were not credentialed with the Medicare program at the time CityMD billed Medicare for their services.
- CityMD falsely billed Medicare for services rendered by these uncredentialed physicians using the National Provider Identification numbers of other credentialed physicians who did not actually render the services in question.
The federal government joined a private whistleblower lawsuit that had been filed under seal.
CityMD issued the following statement Friday afternoon:
"CityMD is pleased to have reached a satisfactory resolution to this matter, which involved past insurance billing and coding. This matter was unrelated to CityMD's patient care, which has consistently been of the highest quality."
"Throughout CityMD's history, and especially over the past year, we have made substantial investments in strengthening our compliance program, which has included the enhancement and implementation of detailed compliance policies and procedures and the appointment of a new, full-time chief compliance officer."
"We earn the trust of the communities we serve by providing an exceptional experience through high-quality medical care and convenient access, and that includes ensuring everyone at CityMD understands that they are an integral part of our business and adheres to best-in-class compliance practices."
John Commins is a senior editor at HealthLeaders.