False Claims Act lawsuit reveals upcoding of urgent care visits by CareWell in Massachusetts and Rhode Island at the expense of Medicare and Medicaid
BOSTON, MA. ***FOR IMMEDIATE RELEASE*** CareWell Urgent Care Centers, an urgent care company which operates seventeen (17) urgent care centers in Massachusetts and one (1) in Rhode Island, will pay over $2.1 million dollars with interest to settle False Claims Act whistleblower claims against it, for its fraudulent billing of Medicare and Medicaid for services it provided which were unrelated to patients’ individual medical needs. The original whistleblower case was filed on behalf of the federal and state Governments by Registered Nurse Practitioner Aileen Cartier of Massachusetts, who worked in some of CareWell’s clinics from 2016 to early 2018. Ms. Cartier is represented by Attorney Jeffrey A. Newman of Massachusetts.
The fraudulent billing by CareWell included requirements that all of its providers give the patients histories and physical examinations which far exceeded the purposes for which they went to the clinics. According to the Complaint, CareWell’s physicians, nurse practitioners and other medical personnel were directed by management to examine and document at least 13 body systems during the medical history inquiries and at least 9 body systems during physical examinations, even if, for example, the patient’s original complaint was as simple as a splinter in the finger. This was done so that CareWell could upcode claims to a Level 4 code in order to receive more reimbursement funds. In addition, the evidence revealed that CareWell’s management informed medical personnel that the mandate of inquiring into body symptoms unrelated to a patient’s specific medical complaints or symptoms was a requirement imposed by CareWell’s malpractice insurance carrier. According to the Settlement Agreement: “…no malpractice insurance carrier imposed this requirement on CareWell.”