Medical Reimbursement Systems violated the False Claims Act by fraudulently certifying one of its clients provided medical services in a health professional shortage area. Physicians who provide covered services in areas designated as geographic HPSAs are entitled to receive 10 percent bonus payments above the amount ordinarily reimbursed by Medicare-covered professional services. The bonuses are also available to healthcare providers who treat TRICARE beneficiaries in areas that qualify for the Medicare bonus, according to the DOJ.
In 2009, Medical Reimbursement Systems entered into a billing services agreement with a Watertown, N.Y.-based physician group. The physician group did not qualify for HPSA bonuses from TRICARE. However, Medicare Reimbursement Systems complied with the physician group’s request to certify to TRICARE that services were rendered in a qualifying HPSA.
Medical Reimbursement Systems admitted it was inappropriate for it to have sought HPSA bonuses for the physician group, and the company also agreed to hire an outside consultant to conduct TRICARE-specific billing training for its staff and appoint a new compliance officer, according to the DOJ.
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