On Wednesday, July 26, 2023, the U.S. Attorney’s Office for the Western District of Michigan announced that Edward W. Sparrow Hospital Association d/b/a Sparrow Medical Group, Sparrow Care Network, and Sparrow Health System (“Sparrow”) agreed to pay $671,310.00 to settle allegations that they violated the federal False Claims Act.
The settlement relates to claims brought by whistleblower and Hoyer Law Group client Patricia M. Crowe who alleged that Sparrow engaged in fraudulent “incident-to” billing practices. “Incident-to” billing refers to using nurse practitioners and physician assistants to treat a patient but bill federal healthcare programs under a physician’s name, so long as the practice meets specific criteria. Those criteria include the presence of an on-site doctor, that a physician performs the patient’s initial visit, and that the physician develops a diagnosis and treatment plan during the initial visit. So long these criteria are met, physicians or their practice can bill federal healthcare programs for 100 percent reimbursement rather than the 85 percent rate paid for physician assistants and nurse practitioners.
The claims against Sparrow alleged that it improperly billed services under a physician’s name when the services were rendered by mid-level providers and locations where the “incident-to” criteria were not met.
Improper billing practices are among the most wasteful practices facing federal healthcare programs and draw valuable resources away from those needing medical services. Hoyer Law Group is proud to have assisted in resolving these claims and in returning taxpayer dollars to the Medicare program.