UMC Physicians to Pay $3 Million for False Billing Allegations

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The Estate of Dr. Kenneth Michael Rice and UMC Physicians (UMCP) have agreed to pay a total of $3.28 million to the United States and the State of Texas to settle allegations that Rice and UMCP violated the False Claims Act, announced in a press release from the U.S. Department of Justice, Northern District of Texas.

Specifically, the United States alleged that Rice, by and through UMCP, submitted false claims for payment to Medicaid and Medicare related to in-person evaluation and management services, as well as critical care services.

The Estate of Dr. Rice agreed to pay the United States and the State of Texas $2 million, collectively, to settle the allegations. UMCP agreed to pay $1.28 million to settle the matter.

UMCP, a physician practice management group located in Lubbock, Texas, employs healthcare providers for its sole managing member, the Lubbock County Hospital District d/b/a UMC Health System (UMC).  UMCP employed Dr. Kenneth Michael Rice as a healthcare provider through his death on Feb. 4, 2015.

The settlement resolves allegations that from January 2008 through February 2015, Rice, by and through UMCP, billed Medicare and Medicaid for in-person evaluation and management services at the higher physician fee rate, even though the services were often provided by non­physician providers.

Rice and UMCP are also alleged to have billed normal evaluation and management services to Medicare at the higher critical-care rate. The Estate and UMCP deny the allegations.

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