The company that owns Peachtree Immediate Care, the Emory Healthcare network’s chain of urgent care clinics, will pay $1.6 million to settle a lawsuit claiming that during the pandemic the clinics charged for doctor visits that never happened.
The claims were detailed in a lawsuit filed under the False Claims Act by the federal government and the state of Georgia on behalf of a whistleblower who worked for the company that owns Peachtree Immediate Care, CRH Healthcare.
The company did not admit wrongdoing. Cobb-County based CRH Healthcare runs clinics in four states including Georgia, and all used the same billing office, according to the suit.
During the pandemic, COVID-19 testing was big business for health care facilities, with the federal government often covering the cost of the tests or requiring that insurance do so. Peachtree Immediate Care set up drive-through COVID-19 testing outside their clinics as well as inside. In both the drive-through and in-clinic settings, whenever patients only wanted a COVID test, they were seen and swabbed by lower-level staff like nurse practitioners or medical assistants, not by doctors, according to the suit.
According to billing rules, those visits cost less than a test and evaluation where a doctor would see the patient face-to-face.
The lawsuit alleges that Peachtree Immediate Care billed for tests that included a doctor visit anyway, using billing codes that indicated the patient was seen by a doctor.
In 2020 and 2021, according to the suit, healthcare facilities were allowed to bill Medicare for doctor visits at three to 10 times the price of the simple COVID test.
The lawsuit says the company filed such false claims thousands of times to government-funded health insurance programs such as Medicare, Medicaid and TRICARE.
The whistleblower named in the suit, Karlene Hollimon, had worked in billing at CRH since 2017, and in the pandemic she was placed in billing customer service.
During the pandemic, the federal government loosened the rules for whether a patient had to have an established relationship with a doctor in order to submit certain doctor-visit billing codes. But that didn’t mean the clinics could bill for face-to-face doctor visits that never happened, the government says.
Patients who visited Peachtree Immediate Care started hearing back from their insurance providers that the bills were wrong, Hollimon’s complaint says. As a result, the suit suggests, some were asked to pay out of pocket for what should have been a free COVID test.
When Hollimon and her colleagues tried to sort out the complaints, their boss stood firm, according to the suit.
CRH continued submitting thousands of incorrect claims, according to the suit, overbilling taxpayer-funded insurance programs by millions of dollars.
Within a short time of Hollimon’s last complaint to the billing director, the suit alleges, in October 2021 the company fired Hollimon “for poor performance.” She will receive a portion of the settlement, according to the U.S. Department of Justice.
Representatives for CRH Healthcare and Emory Healthcare did not respond Tuesday afternoon to a request for comment on the settlement. A spokesman for Emory said that Emory does not own Peachtree Immediate Care, but is their partner.
The case was investigated by the U.S. Department of Health and Human Services, Office of Inspector General and the Federal Bureau of Investigation.
“The FBI is thankful for the honesty of the whistleblowers who stepped forward to identify this alleged fraud,” Keri Farley, Special Agent in Charge of FBI Atlanta, said in a statement.
“When providers submit improper claims to Medicare, they waste valuable taxpayer dollars,” said Tamala E. Miles, Special Agent in Charge with the Department of Health and Human Services, Office of Inspector General (HHS-OIG). “Health care providers played a critical role in keeping our nation safe during the COVID-19 pandemic,” and the funds must be safeguarded “to ensure they can be used for their intended purposes.”