Arizona-based Nextcare Inc. to Pay US $10 Million to Resolve False Claims Act Allegations

Allegedly Charged for Unnecessary Testing and Inflated Billing for Urgent Care Medical Services NextCare Inc., an Arizona-based company, has agreed to pay $10 million to settle federal and state allegations that it submitted false claims. NextCare is an owner of a chain of urgent care facilities with locations in Arizona, Colorado, Texas, North Carolina, Ohio and Virginia. The settlement resolves allegations that NextCare submitted false claims to Medicare, TRICARE and the Federal Employees Health Benefits Program, as well as the Medicaid programs of Colorado, Virginia, Texas, North Carolina and Arizona, by billing for unnecessary allergy, H1N1 virus and respiratory panel testing. The United States also alleged that NextCare inflated billings for urgent care medical services in the years under review, a practice known as upcoding. As a condition of the settlement, NextCare Inc. is also required to enter into a Corporate Integrity Agreement with HHS-OIG under which the company will be monitored for a period of five years to ensure that in the future it complies with all federal healthcare program rules. The allegations resolved by this settlement were initially raised in a lawsuit filed against NextCare by former NextCare employee Lorin Cohen. Under the False Claims Act, private citizens acting as relators can bring suit on behalf of the United States and share in the recovery. Ms. Cohen will receive $1.614 million as her share of the recovery. This matter was handled jointly by the Civil Division of the United States Department of Justice, the U.S. Attorneys Office for the Western District of North Carolina, the FBI, the North Carolina Attorney Generals Office, the Office of Inspector General of the Department of Health and Human Services (HHS-OIG), the TRICARE Management Activity and the Office of Personnel Management (OPM), which administers the FEHBP. The claims settled by this agreement are allegations only, and there has been no determination of liability.