South Carolina’s Largest Urgent Care Provider and its Management Company to Pay $22.5 Million to Settle False Claims Act Allegations
Columbia, S.C (STL.News) Acting United States Attorney for the District of South Carolina M. Rhett DeHart announced today that Doctors Care, P.A. (“Doctors Care”) – South Carolina’s largest urgent care provider network – and its management company, UCI Medical Affiliates of South Carolina, Inc. (“UCI”), will pay $22.5 million to resolve civil allegations of healthcare fraud in violation of the False Claims Act.
The case began with a whistleblower complaint alleging that Doctors Care, UCI, and UCI Medical Affiliates, Inc. (a related holding company), falsely certified that certain urgent care visits were performed by providers who were credentialed to bill Medicaid, Medicare, and TRICARE for medical services. Whereas, the services were performed by non-credentialed providers, according to the complaint.
Federal health insurance companies require physicians and midlevel providers to apply for and receive approval to bill any services to the insurer. This approval is known as a provider’s “billing credentials.” Providers are obligated to renew these billing credentials periodically and must obtain new credentials with new employment.
As early as 2013 and continuing to 2018, it is alleged that UCI was unable to secure and maintain necessary billing credentials for most Doctors Care providers.