City Medical of the Upper East Side, PLLC, Summit Medical Group, P.A., Summit Health Management, LLC, and Village Practice Management Company, LLC, collectively known as CityMD, have agreed to pay $12,037,109 to settle allegations of violating the False Claims Act. The accusations involve submitting false claims for COVID-19 testing payments to a Health Resources and Services Administration (HRSA) program intended for uninsured patients.
The HRSA's COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured Program (the Uninsured Program) reimbursed healthcare providers at Medicare rates for testing uninsured individuals for COVID-19. The Justice Department alleges that from February 4, 2020, through April 5, 2022, CityMD knowingly submitted false claims for insured individuals. It is contended that CityMD did not adequately verify insurance status before submitting these claims and caused outside laboratories to do the same by issuing requisition forms incorrectly indicating patients were uninsured.
CityMD received credit in the settlement under department guidelines due to voluntary disclosure and cooperation. They contracted with a third party to assist in determining the amount of losses related to these claims.
Principal Deputy Assistant Attorney General Brian M. Boynton stated: “The Uninsured Program provided critical financial support for COVID-19 related testing and treatment for uninsured Americans during the height of the pandemic. Today’s settlement reflects the department’s commitment to ensuring that the pandemic relief programs created by Congress were used as intended.”
U.S. Attorney Philip R. Sellinger added: “Uninsured Americans who were at risk from COVID-19 were covered by emergency funding programs that made available to them the testing, vaccines, and treatments that they needed. The alleged misuse of these funds is something we cannot and will not tolerate. Today’s settlement ensures that the money that was obtained inappropriately will be returned to the government.”
This civil settlement also resolves claims brought under qui tam or whistleblower provisions by Steven Kitzinger, a patient of CityMD. Under these provisions, private parties can file actions on behalf of the United States and receive a portion of any recovery; Mr. Kitzinger will receive $2,046,308 as his share.
The resolution resulted from coordinated efforts between various divisions within the Justice Department and assistance from other federal agencies.
On May 17, 2021, the Attorney General established the COVID-19 Fraud Enforcement Task Force to enhance efforts against pandemic-related fraud by leveraging resources across federal agencies.
Information about attempted fraud involving COVID-19 can be reported via several channels provided by federal agencies.
Trial Attorney Daniel Meyler of the Civil Division’s Fraud Section and Assistant U.S. Attorney Mark Orlowski handled this matter.
The resolved claims are allegations only with no determination of liability made.
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