Scripps Health to pay $1.5M in settlement

San Diego-based Scripps Health has agreed to pay $1.5 million to resolve allegations that it violated the False Claims Act by charging Medicare and TRICARE for physical therapy services provided by therapists without billing privileges and without the appropriate supervision by a physician, the U.S. Attorney’s Office announced.

The claims resolved by the settlement announced Friday are allegations only and there has been no determination of liability.

Medicare and TRICARE limit billing privileges to enrolled providers. Services from unenrolled providers can be billed as “incident to” the services of an enrolled physician, but only if the physician provided direct supervision.

The settlement resolves allegations filed in a lawsuit by a former Scripps employee under the qui tam provisions of the False Claims Act, which permit private individuals to sue for false claims on behalf of the government and to share in any recovery.

The government’s resolution of this matter illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act, the U.S. Attorney’s Office reported.

Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services at 800-HHS-TIPS.