BOSTON – CareWell Urgent Care Centers — with two locations in Worcester — will pay a combined $2 million to resolve allegations that the company routinely overbilled government insurance programs in Massachusetts and Rhode Island, including the state’s Medicaid Program (MassHealth) and insurance plans administered by the state’s Group Insurance Commission (GIC),
According to Attorney General Maura Healey’s office, CareWell will pay nearly $858,000 to resolve claims relating to Massachusetts.
The settlement is a result of a joint investigation by the AG’s Office, the United States Attorney’s Office in Boston and the Rhode Island Attorney General’s Office.
“Urgent care centers provide necessary, time-sensitive care to families across Massachusetts,” Healey said. “CareWell took advantage of patients in Massachusetts by giving them exams they did not need, while at the same time overbilling the state and wasting critical health care resources.”
Carewell has locations on Greenwood St. and Lincoln St. in Worcester and across Central Massachusetts — in Northborough, Marlborough and Fitchburg.
The AG’s Office claims that beginning in March 2013, CareWell routinely overbilled MassHealth and GIC Plans for complex patient exams that were not medically necessary. The company directed its physicians, nurse practitioners and medical staff to perform these complex exams to support CareWell’s claims for higher government reimbursements, and falsely informing medical personnel that the complex exams were required by CareWell’s malpractice carrier. Additionally, when CareWell’s medical staff did not comply with this directive, non-medical staff were instructed to alter electronic billing records to ensure maximum reimbursement.
The AG’s Office also alleges that CareWell falsely billed for services provided by nurse practitioners as services provided by physicians, which offer a higher rate of reimbursement. The AG’s Office said that this was done knowingly by CareWell’s management.
Under the terms of the settlement, CareWell will pay $857,800 to resolve claims relating to Massachusetts. Of that amount, $352,000 is allocated to false claims submitted to GIC Plans, which provide health insurance to state employees, and $505,800 is allocated to false claims submitted to MassHealth.
The remainder of the $2 million settlement will be split between the State of Rhode Island and the Federal Government. CareWell has also agreed to implement a compliance program to ensure that its billing is in compliance with all rules, regulations and laws applicable to participation in the Commonwealth’s Medicaid and GIC programs.
The investigation stemmed from a qui tam action brought by a whistleblower in the United States District Court for the District of Massachusetts alleging claims under the federal False Claims Act and the Massachusetts False Claims Act. The settlement agreement resolves allegations pertaining to all 17 CareWell locations in Massachusetts and Rhode Island.