CareWell to Pay $2M for Overbilling

March 30, 2019 GMT

BOSTON -- CareWell Urgent Care Centers has agreed to pay a combined $2 million to Massachusetts, Rhode Island and the federal government to resolve allegations that it routinely overbilled government insurance programs, including the state’s Medicaid Program (MassHealth) and insurance plans administered by the state’s Group Insurance Commission, Attorney General Maura Healey announced Friday.

CareWell, which operates a facility in Fitchburg, will pay nearly $858,000 to resolve claims relating to Massachusetts. The settlement is a result of a joint investigation by the AG’s Office, the U.S. Attorney’s Office in Boston and the Rhode Island Attorney General’s Office.

“Urgent care centers provide necessary, time-sensitive care to families across Massachusetts,” said Healey. “CareWell took advantage of patients in Massachusetts by giving them exams they did not need, while at the same time overbilling the state and wasting critical health care resources.”

Healey’s office alleges that beginning in March 2013, CareWell routinely overbilled MassHealth and GIC Plans for complex patient exams that were not medically necessary. Healey alleges that CareWell directed its physicians, nurse practitioners and medical staff to perform these complex exams to support CareWell’s claims for higher government reimbursements, and falsely informing medical personnel that the complex exams were required by CareWell’s malpractice carrier. Healey’s office also alleges that when CareWell’s medical staff did not comply with this directive, non-medical staff were instructed to alter electronic billing records to ensure maximum reimbursement.

In addition, the Healey’s office alleges that CareWell falsely billed for services provided by nurse practitioners as services provided by physicians, which offer a higher rate of reimbursement. Healey’s office alleges that this was done knowingly by CareWell’s management.

Under the terms of the settlement, CareWell will pay $857,800 to resolve claims relating to Massachusetts. Of that amount, $352,000 is allocated to false claims submitted to GIC Plans, which provide health insurance to state employees, and $505,800 is allocated to false claims submitted to MassHealth. The remainder of the $2 million settlement will be split between the State of Rhode Island and the Federal Government.

CareWell has also agreed to implement a compliance program to ensure that its billing is in compliance with all rules, regulations and laws applicable to participation in the Commonwealth’s Medicaid and GIC programs.

The investigation stemmed from an action brought by a whistleblower in the U.S. District Court for the District of Massachusetts alleging claims under the federal False Claims Act and the Massachusetts False Claims Act. The settlement agreement resolves allegations pertaining to all 17 CareWell locations in Massachusetts and Rhode Island.