Healogics, Inc., a Florida-based provider of wound care services with clinics across the country, agreed to pay $398,162.69 to resolve False Claims Act allegations pertaining to improper coding. Specifically, the United States alleged that, from January 1, 2012, through June 30, 2017, Healogics submitted claims to Medicare, Medicaid, and Tricare using Modifier 25 to signify that a separate evaluation and management service was performed on the same date as another procedure when no such separate service was performed.
Because a private citizen filed a qui tam, or whistleblower, lawsuit raising the civil allegations, Healogics agreed to pay the citizen’s law firm an additional $48,694.37 in fees. That private citizen is also entitled to receive $91,577.42 of the recovery pursuant to the qui tam provisions of the False Claims Act. Those provisions permit private individuals with knowledge of wrongdoing to bring suit on behalf of the government for false claims and share in any recovery.
“This is yet another example of our office’s commitment to ensuring taxpayer money is well spent and health care providers play on a level playing field,” said United States Attorney Peter E. Deegan, Jr. “We encourage citizens with knowledge of wrongdoing by health care providers to bring those matters to our office’s attention.”
The case was investigated by the Department of Health and Human Services Office of Inspector General. The case file number is 16-cv-3016-MWB.
The claims settled by this agreement are allegations only, and there has been no determination of liability.