Bluestone reaches $14.9 million settlement over improper payment allegations

Bluestone Physician Services, which serves patients with chronic conditions in Florida, Minnesota and Wisconsin, will pay $14.9 million to resolve claims it improperly billed government healthcare programs.

The settlement will resolve allegations that, between the start of 2015 and the end of 2019, Bluestone knowingly submitted claims for home visits and chronic care management that did not support the level of service provided.

“Improperly billing federal healthcare programs depletes valuable government resources used to provide medical care to millions of Americans,” said Brian Bonyton, principal deputy assistant attorney general and head of the U.S. Justice Department’s Civil Division. “We will pursue healthcare providers that defraud the taxpayers by knowingly submitting inflated claims.”

Overall, the federal government will receive $13.8 million, while Florida and Minnesota will receive $1.1 million.

The settlement will also resolve claims under whistleblower provisions of a federal law that allows private parties to sue on behalf of the U.S. and receive a portion of any recovery. A former general manager for Bluestone’s Florida market will receive $2.8 million in connection with the agreement.

Bluestone has entered into a five-year corporate integrity agreement where it will establish a compliance program and submit Medicare claims to an independent review organization to ensure medical necessity, appropriate documentation and correct coding.

Bluestone said “nothing about this matter” relates to the efficacy of the healthcare they provide and instead relates to medical record documentation issues that occurred under prior management.

“While we deny the allegations, we have agreed to this settlement so we can focus exclusively on bringing effective, high-quality care to the fragile- and medically complex patients who rely on us,” they said in a statement.

This article first appeared in the Wisconsin Health News daily email newsletter. Sign up for your free trial here.