Physician Partners of America: More Visits to Make up for Lost Procedures
In the Physician Partners America telemedicine settlement, the company agreed to pay $24.5 million to resolve allegations that included unnecessary repeat visits scheduled to replace lost procedure revenue. The government said patients who had been seen monthly were brought back every two weeks, and physicians were instructed to use inappropriate high-level billing codes. The alleged cost fell on pain patients brought back without a clinical need and on the taxpayer-funded programs billed for those visits. For someone inside scheduling, clinical operations or billing, the allegation is recognizable: a revenue problem became a patient appointment.
The Justice Department announced the settlement on April 12, 2022. It covered testing, physician compensation, anesthesia billing and a pandemic-relief loan as well as telemedicine.
How Lost Procedure Revenue Changed the Visit Schedule
Physician Partners of America allegedly increased the frequency of telemedicine visits to make up for canceled elective interventional pain procedures. Florida suspended non-emergency medical procedures in March 2020 to reduce transmission of COVID-19. According to the government’s account, the company responded by directing physicians to schedule evaluation and management appointments every 14 days instead of every month.
The executed settlement agreement identifies the telemedicine conduct as running from April 1, 2020 through November 8, 2021. The United States and Florida alleged that physicians scheduled those appointments regardless of patient need, generating additional billings and revenue. The claims went to Medicare, the Department of Veterans Affairs and Florida Medicaid.
The Justice Department’s announcement adds the coding instruction: the company allegedly told physicians to bill the visits using inappropriate high-level procedure codes. The alleged revenue strategy therefore reached both the appointment calendar and the claim. More visits supplied more billing opportunities, while the coding instruction sought payment at an unjustified level.
The government tied the new schedule to the loss of procedure revenue and said patient need did not determine the return interval. That puts the management instruction at the center of the story. The patient’s next appointment allegedly answered the business’s need for another bill.
The Practice, the Laboratories and the Other Allegations
Physician Partners of America was a Tampa-based practice-management company managing Florida Pain Relief Group and Texas Pain Relief Group. The settlement’s company parties also included Physician Partners of America CRNA Holdings, Medical Tox Labs and Medical DNA Labs. Its founder and former chief medical officer settled too.
That structure helps explain why the case reached beyond the telemedicine encounter. A management company can influence staffing, billing and collections across professional practices, while the clinician appears on the patient’s visit. Management agreements and operating instructions help show where decisions came from. Here, the government attributed the scheduling and coding instructions to Physician Partners of America itself.
The testing allegations describe a similar company-wide approach to patient care. The government alleged that the company required multiple urine drug tests without first deciding whether testing was necessary or reviewing initial results to see whether further testing was warranted. Its toxicology laboratory then allegedly billed for the highest level of testing. Physicians allegedly received 40% of the profits from the initial urine tests they ordered. The government challenged that payment arrangement under the physician self-referral law.
For genetic and psychological testing, the government alleged that the company required patients to undergo tests before physicians saw them. The agreement describes medical assistants ordering tests under a standard protocol without treating-physician review. The business instruction allegedly came before the individual clinical decision.
The anesthesia allegation concerned local anesthesia billed to Medicare as monitored anesthesia care to obtain greater reimbursement. The loan allegation concerned a false certification that the company was not engaged in unlawful activity when it applied for a $5.9 million Paycheck Protection Program loan, while the government said the health care overbilling was underway.
These allegations explain the breadth of the settlement. The repeat-visit schedule was one way the government said the company turned business instructions into unnecessary or inflated claims.
Four Whistleblower Cases Behind One Settlement
Current or former employees of Physician Partners of America or its affiliated entities brought four False Claims Act cases in the Middle District of Florida. The agreement brought the covered allegations from those cases into one settlement and provided for the United States to join them in part. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.
The employees’ cases reached a business with professional practices, laboratories and management functions. That is why the company roster matters: the settlement names the businesses sharing responsibility for the payment, alongside the founder and former chief medical officer.
Oversight Reached the Claims and Testing Referrals
Physician Partners of America also entered a five-year Corporate Integrity Agreement with the Department of Health and Human Services Office of Inspector General. The announced requirements included management certifications, independent annual claims reviews and monitoring of testing referrals.
Those requirements reached the same parts of the business described in the allegations: management, ordering and billing. Reviewing the claim addresses what the government was charged. Reviewing the referral and management process addresses how that charge came to exist.
What an Insider Can See Behind the Appointment
The useful connection in a repeat-visit case runs from the revenue instruction to the schedule, the clinical record and the billed service. In the company’s alleged model, the additional encounter itself generated another claim.
An insider may know who set the return interval, what reason staff were given and whether clinicians could change it for individual patients. Scheduling instructions, encounter records, billing-code directions and compensation records put different parts of that decision beside each other. We work with the person who understands those records to connect the business decision to the claims it produced.
A Parallel in Recurring Prescription Visits
A nurse practitioner’s whistleblower complaint against Cerebral also connected a treatment model to recurring telehealth appointments. The complaint alleged:
Cerebral recognized and took advantage of the large economic potential for treating patients with ADHD using stimulants. In addition to stimulants like Adderall being known as having a high potential for abuse, continuation of Adderall prescriptions requires frequent telehealth visits.
Whistleblower’s allegation, United States of America ex rel. Keaton v. Cerebral, Inc. and Cerebral Medical Group, P.A., complaint, June 22, 2022
The comparison is the alleged incentive: a business gains recurring encounters from a treatment or scheduling decision. Physician Partners of America’s case supplies the more direct account of management allegedly setting the return interval to replace a particular lost revenue stream.
You Know Who Set the Schedule
If you saw appointments added to meet revenue targets or billing codes dictated before the clinical work, speak with our whistleblower experts. We build the case with you around the instructions, the patient records and the resulting claims, and bring in healthcare fraud whistleblower lawyers who know physician-practice billing. We stay beside you through the whole journey to build your strongest healthcare whistleblower case.
