Medical Group Settles False Claims Allegations Involving Telehealth

Physician Partners of America (PPOA) and two of its leaders will pay $24.5 million to resolve allegations that they fraudulently billed federal and state healthcare programs for unnecessary medical services, including some conducted via telehealth, the Department of Justice (DOJ) announced.

The United States and the state of Florida alleged that from April 1, 2020, through Nov. 8, 2021, the medical group — which provides care for a wide array of musculoskeletal pain conditions — submitted false claims to the Medicare, Veterans Affairs, and Medicaid programs for medically unnecessary evaluation and management (E/M) telemedicine services, thereby violating the False Claims Act.

The telemedicine visits occurred after non-emergency medical procedures were paused statewide on March 20, 2020.

"PPOA instructed medical providers to begin seeing patients by telemedicine twice a month," the settlement agreement states. "The increased number of E/M telemedicine visits was designed to make up for lost revenue from the cancellation of elective interventional pain procedures."

The US and the state of Florida further alleged that PPOA physicians subsequently scheduled telehealth appointments every two weeks "regardless of patient need."

Simultaneously, the medical group applied for a Paycheck Protection Program (PPP) loan, falsely stating that it was not engaged in illegal activity. It obtained a $5.9 million loan through the PPP.

In addition, the settlement states that PPOA submitted claims for medically unnecessary urine drug testing. The group required its physicians to order multiple tests without determining whether testing was necessary. PPOA's affiliated toxicology laboratory then allegedly billed federal programs for the highest-level testing.

PPOA also allegedly paid its physicians 40 percent of the profits to order presumptive urine drug testing.

"Billing federal healthcare programs for services that providers know are unnecessary or unreasonable undermines the quality of care that patients receive and increases the costs of these taxpayer-funded programs," said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the DOJ's Civil Division. "The department is committed to ensuring that healthcare providers base their treatment decisions on their patients' needs rather than their own financial interests."

PPOA has denied the allegations, and the settlement is neither an admission of liability from PPOA nor a concession by the plaintiffs that their claims are not well-founded.

As telehealth use continues to be a popular care delivery mechanism among providers, payers, and patients, federal regulators are cracking down on False Claims Act enforcement in the virtual care arena.

At the end of last year, four individuals were charged for their involvement in a telemedicine fraud scheme that bilked public and private payers out of $37 million.

Further, lawyers working in the healthcare arena say that they have noticed a higher volume of healthcare fraud and False Claims Act cases driven by the digitization of healthcare, including the increase in telehealth and EHR use.

"Holding healthcare providers accountable for inflated claims and false statements helps ensure the integrity of the healthcare system as a whole," said U.S. Attorney Roger B. Handberg for the Middle District of Florida in the press release. "Settlements like this one [with PPOA] are an important step in that direction."