Texas clinics face potential $300M fine for submitting 20K false claims

A chain of clinics in Texas is facing a potential $300 million fine after a jury ruled it knowingly submitted more than 20,000 fraudulent reimbursement claims to Medicare.

The lawsuit against Healthcare Associates of Texas (HCAT), which operates eight provider clinics in Northern Texas, was brought by a former employee turned whistleblower, Cheryl Taylor, who noticed the inflated claims and misrepresented care delivery during her time in the billing office.

According to coverage from the Dallas Morning News, the clinics were accused of billing for frivolous labs, imaging scans, and other tests, as well as manipulating medical charts to justify the procedures. In some cases, physicians were reimbursed for care provided by non-physician staff.

The acts of fraud occurred between 2015 and 2021, with the lawsuit initially identifying more than 47,000 bogus Medicare claims. The damage to government healthcare programs was estimated to be around $2.8 million.

However, penalties for a single knowingly false claim submitted to Medicare range from about $14,000 to nearly $28,000. In total, HCAT could be on the hook for a $300 million judgment.

The provider network is owned and operated by Optum, a subsidiary of UnitedHealth Group. However, the company did not purchase HCAT until 2022, at least a year after the fraud took place.

As part of an investigation by the U.S. Department of Justice into the claims made by Taylor, multiple HCAT employees, including physicians, could face criminal and civil penalties.

The lawsuit against HCAT was filed in the Dallas Division of the U.S. District Court of Texas.

After a fine is levied by the court, Taylor will receive a substantial award for reporting the fraud.

For more, read the full story from the Dallas Morning News at the link below.