“We appreciate the work being done throughout California to combat insurance fraud. Wrongful billing doesn’t just affect insurance companies—it impacts everyone by driving up insurance premiums and increasing the overall cost of healthcare.”
CSLEA President Alan Barcelona
SAN FRANCISCO – On July 6, San Francisco District Attorney Brooke Jenkins announced that her office, together with the California Department of Insurance (CDI) and the United States Attorney for the Northern District of California, entered into a $3,325,000 civil settlement in a medical billing fraud case brought against Circle Medical Care of California, Circle Medical Technologies, Inc., and their Chief Medical Officer and medical director Dr. Nicole Tsang, D.O. (collectively, “Circle Medical”).
“Medical providers have a legal duty to ensure that their practices comply with the law, particularly as it relates to the accuracy of claims submitted to insurance companies for reimbursement,” said District Attorney Brooke Jenkins. “Because the cost to insurance carriers is eventually passed along to the public, my office won’t hesitate to act when it appears that medical claims are improper. I am very pleased to have partnered with other law enforcement agencies on this matter, particular the California Department of Insurance.”
Circle Medical is a San Francisco-based company that operates an on-line telehealth platform through which it offers medical services, including mental health treatment. The complaint alleges that, for years, Circle submitted claims for reimbursement to both federal payers and commercial insurance providers using the NPI (National Provider Identifier) number of physicians who did not actually provide the treatment services. The complaint further alleges that, in many instances, the services were provided by contracted professionals, including nurse practitioners and physician assistants, who had not yet been credentialed (approved) by the insurance companies which were billed.
The action was initially filed as a whistleblower lawsuit by a former employee of Circle. The San Francisco District Attorney’s Office and CDI intervened on behalf of the State of California under the California Insurance Frauds Prevention Act (Insurance Code section 1871.7.) Although there was no evidence of Circle billing for services that were not provided, the use of improper NPI numbers was unlawful as alleged in the complaint, and, in many instances, resulted in higher billing rates.
Under the terms of the settlement agreement, and without admitting liability, Circle agreed to pay $475,000 to the United States and $2,850,000 to California. Of those amounts, the whistleblower will receive $80,750 from the United States and $997,500 from California. The San Francisco District Attorney’s Office received a total payment of $926,250, which will be used to investigate and prosecute fraud cases. Following settlement, the Court entered a stipulation of dismissal of the underlying claims.
