IPC Healthcare

Last updated
IPC Healthcare, Inc.
FormerlyIPC The Hospitalist Company
Company type Public
Nasdaq: IPCM
Founded1995;29 years ago (1995)
Headquarters,
United States  OOjs UI icon edit-ltr-progressive.svg
Parent TeamHealth

IPC Healthcare, Inc., previously known as IPC The Hospitalist Company, was a publicly traded corporation which operates a national physician group practice focused on the delivery of hospital medicine and related facility-based services. IPC providers manage the care of patients in coordination with primary care physicians and specialists in over 1,900 facilities in 28 states across the U.S. [1] The company name is derived from an earlier company called In-Patient Consultants Management, Inc. and the NASDAQ ticker name was changed to IPCM in 2008. [2] The company changed its name to IPC Healthcare in January 2015. [3] The company was acquired by TeamHealth in 2015 for $1.6 billion. [4]

Adam Dean Singer (born in Los Angeles on April 20, 1960) has been director, Chairman, and Chief Executive Officer of IPC since he founded the company in 1995, and in 2006, was designated as the Chief Medical Officer. In 1991, Singer acquired a private practice in pulmonary medicine that shortly thereafter merged with two other pulmonary physicians to become part of Consultants For Lung Disease, Inc. [5]

Controversy

The company disclosed that on June 7, 2010, it received a civil investigative demand (CID) issued by the Department of Justice (DOJ), U.S. Attorney's Office for the Northern District of Illinois. The CID requested information concerning claims that IPC had submitted to Medicare and Medicaid.

In 2011, the company was the subject of an investigative report looking at the use of hospitalists in San Antonio area hospitals and at the death of a patient under an IPC physician's care. [6] A 2013 article published by JAMA raised concerns about the quality of care provided by hospitalists with excessive workloads. [7] [8]

In 2013, the US Justice Department joined a "whistleblower" lawsuit against IPC, alleging that IPC physicians sought payment for higher and more expensive levels of medical service than were actually performed – a practice commonly referred to as "upcoding". Specifically, the lawsuit alleges that IPC encouraged its physicians to bill at the highest levels regardless of the level of service provided, trained physicians to use higher level codes and encouraged physicians with lower billing levels to "catch up" to their peers. [9] Class action lawsuits against the company for overbilling are now being contemplated by various law firms specializing in such claims. [10] [11]

In February 2014, the former Attorney General of the State of Louisiana announced an investigation into whether IPC officers and/or directors breached their fiduciary duties to IPC's shareholders or otherwise violated state or federal laws.[ citation needed ] In June 2014, the United States Justice Department filed a civil lawsuit against IPC alleging that it submitted false claims to federal health care programs in violation of the False Claims Act by knowingly engaging in systematic overbilling for hospital evaluation and management services billed to Medicare, Medicaid, and other federal health benefit programs. [12]

In February 2017, the company paid $60 million settle the False Claims Act qui tam lawsuit in the Northern District of Illinois. [13] [14] The suit alleged that IPC encouraged and trained physicians in upcoding and utilized incentive compensation schemes linked to billing performance, which in some cases led to incentive compensation exceeding the physician's base salary. [15] [16]

Related Research Articles

<span class="mw-page-title-main">False Claims Act of 1863</span> United States federal law enacted in 1863

The False Claims Act of 1863 (FCA) is an American federal law that imposes liability on persons and companies who defraud governmental programs. It is the federal government's primary litigation tool in combating fraud against the government. The law includes a qui tam provision that allows people who are not affiliated with the government, called "relators" under the law, to file actions on behalf of the government. This is informally called "whistleblowing", especially when the relator is employed by the organization accused in the suit. Persons filing actions under the Act stand to receive a portion of any recovered damages.

<span class="mw-page-title-main">Cigna</span> American health services organization

The Cigna Group is a for-profit American multinational managed healthcare and insurance company based in Bloomfield, Connecticut. Its insurance subsidiaries are major providers of medical, dental, disability, life and accident insurance and related products and services, the majority of which are offered through employers and other groups. Cigna is incorporated in Delaware.

In common law, a writ of qui tam is a writ through which private individuals who assist a prosecution can receive for themselves all or part of the damages or financial penalties recovered by the government as a result of the prosecution. Its name is an abbreviation of the Latin phrase qui tam pro domino rege quam pro se ipso in hac parte sequitur, meaning "[he] who sues in this matter for the king as well as for himself."

<span class="mw-page-title-main">Omnicare</span> American health care company

Omnicare is an American company working in the health-care industry. It was established in April 1981 as a spinoff of healthcare businesses from Chemed and W. R. Grace and Company. It is currently a pharmacy specializing in nursing homes. In 2015, Omnicare was acquired by CVS Health.

Community Health Systems (CHS) is a Fortune 500 company based in Franklin, Tennessee. It was the largest provider of general hospital healthcare services in the United States in terms of number of acute care facilities. In 2014, CHS had around 200 hospitals, but the number had declined to around 85 in 2021.

Centene Corporation is a publicly traded managed care company based in St. Louis, Missouri, which is an intermediary for government-sponsored and privately insured healthcare programs. Centene ranked No. 25 on the 2023 Fortune 500.

Prem N. Reddy is a cardiologist and an owner of Prime Healthcare Services, Inc., which owns 45 hospitals.

In the United States, Medicare fraud is the claiming of Medicare health care reimbursement to which the claimant is not entitled. There are many different types of Medicare fraud, all of which have the same goal: to collect money from the Medicare program illegitimately.

Prime Healthcare Services is a United States privately held healthcare company. It was established in 2001, by chairman and CEO Prem Reddy, MD, and operates 45 hospitals in 14 states. It is affiliated with the nonprofit Prime Healthcare Foundation.

James Hoyer, P.A. is a Tampa, Florida-based law firm that focuses on whistleblower cases as well as consumer class action lawsuits. In 2015, the firm was named Whistleblower Lawyers of the Year by the Taxpayers Against Fraud Education Fund.

Shasta Regional Medical Center, formerly known as Redding Medical Center and Memorial Hospital, is a general acute care hospital that is located in Redding, California. It opened in 1945 and currently has 226 beds with a basic emergency department.

Psychiatric Solutions, Inc. was an operator of psychiatric facilities in the United States.

Health Management Associates was a for-profit corporation which operated hospitals and other health care facilities in the southern United States. It was headquartered at 5811 Pelican Bay Blvd. in North Naples, Florida.

<span class="mw-page-title-main">Elevance Health</span> American healthcare company

Elevance Health, Inc. is an American health insurance provider. Prior to June 2022, Elevance Health was named Anthem, Inc. The company's services include medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans through affiliated companies such as Anthem Blue Cross and Blue Shield, Anthem Blue Cross in California, Wellpoint, and Carelon. It is the largest for-profit managed health care company in the Blue Cross Blue Shield Association. As of 2022, the company had 46.8 million members within its affiliated companies' health plans.

Health care fraud includes "snake oil" marketing, health insurance fraud, drug fraud, and medical fraud. Health insurance fraud occurs when a company or an individual defrauds an insurer or government health care program, such as Medicare or equivalent State programs. The manner in which this is done varies, and persons engaging in fraud are always seeking new ways to circumvent the law. Damages from fraud can be recovered by use of the False Claims Act, most commonly under the qui tam provisions which rewards an individual for being a "whistleblower", or relator (law).

Pharmaceutical fraud is when pharmaceutical companies engage in illegal, fraudulent activities to the detriment of patients and/or insurers. Examples include counterfeit drugs that do not contain the active ingredient, false claims in packaging and marketing, suppression of negative information regarding the efficacy or safety of the drug, and violating pricing regulations.

<i>United States v. GlaxoSmithKline</i>

United States v. GlaxoSmithKline was a case before the United States District Court for the Eastern District of Pennsylvania. Robert J. Merena was one of the first who filed claims against SmithKline Beecham Clinical Laboratories on November 12, 1993. The complaints alleged that GlaxoSmithKline, which operated a system of clinical laboratories, adopted myriad complicated procedures for the purpose of defrauding state and federal healthcare programs, in particular Medicare and Medicaid. The U.S. Justice Department publicly praised Robert Merena for his "cooperation and support" in helping the government collect the largest settlement ever involving a whistle-blower lawsuit. The SmithKline settlement is considered to be one of the largest whistleblower assisted recoveries in the history of the United States.

<span class="mw-page-title-main">All Smiles Dental Centers</span>

All Smiles Dental Centers (ADSC) was an American chain of dental clinics, with its headquarters in Farmers Branch, Texas in the Dallas-Fort Worth area, The chain operates dental clinics in the Dallas-Fort Worth area and in Greater Houston. The company was the management service organization providing business support services to All Smiles Dental Professionals, P.C. The patients mostly consisted of children in low-income Hispanic communities.

The Physician Payments Sunshine Act is a 2010 United States healthcare law to increase transparency of financial relationships between health care providers and pharmaceutical or medical device manufacturers.

<span class="mw-page-title-main">DaVita</span> American dialysis provider

DaVita Inc. provides kidney dialysis services through a network of 2,816 outpatient dialysis centers in the United States, serving 204,200 patients, and 321 outpatient dialysis centers in 10 other countries serving 3,200 patients. The company primarily treats end-stage renal disease (ESRD), which requires patients to undergo dialysis 3 times per week for the rest of their lives unless they receive a donor kidney. The company has a 37% market share in the U.S. dialysis market. It is organized in Delaware and based in Denver.

References

  1. "IPC: The Hospitalist Company". hospitalist.com. Retrieved 2014-03-04.
  2. "IPC The Hospitalist Company, Inc. [IPCM] - 03/31/2008". nasdaq.com. Retrieved 2014-03-04.
  3. "IPC Healthcare". hospitalist.com. Retrieved 2014-03-04.
  4. Carris, Jason. "TeamHealth Announces $1.6 Billion Acquisition of IPC Healthcare". The Hospitalist. Retrieved 16 October 2019.
  5. "IPC: The Hospitalist Company » About Us » Management Team". hospitalist.com. Retrieved 2014-03-04.
  6. "San Antonio Current - News and Politics". m.sacurrent.com. Archived from the original on 2014-02-21. Retrieved 2014-03-04.
  7. "Author Insights: Excessive Workloads for Hospitalists Are Common and Put Patients at Risk « news@JAMA". newsatjama.jama.com. Retrieved 2014-03-04.
  8. "JAMA Network | JAMA Internal Medicine | Impact of Attending Physician Workload on Patient Care: A Survey of Hospitalists". Archived from the original on 2013-02-11. Retrieved 2014-03-04.
  9. "USDOJ: Government Intervenes in False Claims Lawsuit Against Ipc the Hospitalist Co. Inc. Alleging Overbilling of Physician Services". justice.gov. Retrieved 2014-03-04.
  10. "Allen Stewart, P.C. .:. IPC Hospitalist Lawsuit .:. Unfair Hospital Billing Practices". allenstewart.com. Retrieved 2014-03-04.
  11. "Government Intervenes in IPC False Claims Lawsuit | The Chanler Group | Attorneys at Law". chanler.com. Retrieved 2014-03-04.
  12. "U.S. Files Lawsuit Against IPC The Hospitalist Company, Alleges Overbilling Of Federal Health Insurers For Physician Services". www.justice.gov. 23 July 2015.
  13. "IPC Healthcare Agrees to Settle Qui Tam Lawsuit Alleging Company Engaged in Fraudulent Medicaid and Medicare Billing Scheme; Agrees to Pay $60 Million". The National Law Review.
  14. "Healthcare Service Provider to Pay $60 Million to Settle Medicare and Medicaid False Claims Act Allegations". www.justice.gov. 6 February 2017.
  15. "IPC Healthcare Agrees to Settle Qui Tam Lawsuit Alleging Company Engaged in Fraudulent Medicaid and Medicare Billing Scheme; Agrees to Pay $60 Million". The National Law Review. Retrieved 2020-06-22.
  16. "Government Intervenes in False Claims Lawsuit Against Ipc the Hospitalist Co. Inc. Alleging Overbilling of Physician Services". www.justice.gov. 2013-12-09. Retrieved 2020-06-22.