A settlement has been reached in a whistleblower class action lawsuit brought against Janzen, Johnston & Rockwell Emergency Medicine Management Services Inc. (JJ&R), who is accused of submitting false claims to Medicare and Louisiana’s Medicaid program.
The whistleblower will receive $774,450 of the government's recovery.
Originally filed in July 2003, the United States alleged that JJ&R inflated claims that it had coded on behalf of emergency room physicians in Louisiana and California. From approximately 2000 through 2007, JJ&R utilized a coding formula that had a tendency to generate claims for a marginally higher level of evaluation and management service than the physicians had actually provided. In addition, JJ&R routinely added charges to the evaluation and management claim for minor services, such as pulse oximetry, that had been provided by hospital nursing staff or other physicians. Additionally, during this time period, the government alleged that JJ&R often failed to comply with Medicare’s coding rules governing the submission of claims for teaching physicians, resulting in the submission of claims that were not properly payable. While these coding practices had a relatively small impact on the reimbursement of any particular claim, over time they generated significant overpayments from Medicare and Medicaid.
