As for-profit urgent care centers have become a more common part of our healthcare system, so has fraud by these urgent care centers become more common as they put profit and revenue targets ahead of patient care and ethical billing practices. Fraudulent billing at urgent care centers may arise from a variety of practices, including:
- Directing staff to perform unnecessary examinations
- Directing staff to bill all or most visits at a certain level, such as level 4, without regard to patient need
- Requiring that patients who come in for discrete services, such as Covid-19 tests, also agree to full medical examinations
Nurses and other urgent care staff members may become aware of these frauds by urgent centers as they face pressure to satisfy the profit-driven demands of their employers. Thus, for example, Newman & Shapiro attorney recently represented Aileen Cartier, a former employee of CareWell Urgent Centers, in a case where CareWell paid $2 million to resolve allegations that it required its clinicians to conduct, and bill for, unnecessary examinations of body systems that were unrelated to the patients’ health complaints or symptoms. Similarly, in 2020, UCXtra Umbrella, the owner of an Arizona-based chain of urgent care centers, was ordered to pay $12.5 million after it was convicted of causing its providers and staff to overstate the complexity of the medical services they provided and of encouraging providers and staff to order tests and procedures that may not have been medically necessary.
As for-profit urgent care centers proliferate, we expect to see an increasing number of fraud cases brought by whistleblowers. If you have information about an urgent care center that has fraudulently billed a government healthcare program, please contact us here or at 617-917-2875.