Janzen, Johnston & Rockwell Emergency Medicine Management Services Inc. (JJ&R), a provider of billing services for physicians, hospitals and other healthcare providers, has agreed to pay the United States $4.6 million to settle allegations it submitted false claims to Medicare and Louisiana's Medicaid program.
The settlement resolves allegations that JJ&R inflated claims that it coded on behalf of emergency room physicians in Louisiana and California. From approximately 2000 through 2007, the El Segundo, Calif.-based JJ&R utilized a coding formula that had a tendency to generate claims for a marginally higher level of evaluation and management service than the physicians had actually provided.
In addition, JJ&R routinely added charges to the evaluation and management claim for minor services, such as pulse oximetry, that had been provided by hospital nursing staff or other physicians.
Finally, during this time period, JJ&R often failed to comply with Medicare's coding rules governing the submission of claims for teaching physicians, resulting in the submission of claims that were not properly payable. While these coding practices had a relatively small impact on the reimbursement of any particular claim, over time they generated significant overpayments from Medicare and Medicaid.
"Inflating individual healthcare claims by even small amounts can cause significant losses to Medicare and Medicaid," said Tony West, assistant attorney general for the Civil Division of the Department of Justice, in a statement. "Taxpayers should not be on the hook for charges that shouldn't have been added or claims that shouldn't have been submitted."
"In Louisiana's Middle District we are committed to using all available tools, including affirmative civil actions, to combat healthcare fraud," said Donald J. Cazayoux Jr., U.S. Attorney for the Middle District of Alabama.
This settlement resolves allegations that were the subject of a federal investigation and a lawsuit brought by Le Jeanne Harris, a former employee of JJ&R. The lawsuit was filed under the False Claims Act, which enables private persons to sue on behalf of the United States, and to receive a share of any recovery. In this case, Ms. Harris will receive $774,450.