Newspaper article THE JOURNAL RECORD

McKean Defends Company under Fraud Charges

Newspaper article THE JOURNAL RECORD

McKean Defends Company under Fraud Charges

Article excerpt

For Dr. J.D. McKean, launching his medical billing company in the 1980s was a smart business move. But as far as the Department of Justice is concerned, he made some very unwise decisions.

The former emergency room doctor and his company currently face a $1 billion Medicare fraud lawsuit in Oklahoma City's federal court. And whether it's a case of differing opinions or all-out deception is yet to be proved.

The federal government contends that McKean's company -- Emergency Physicians Billing Services -- violated the False Claims Act by "upcoding" emergency medical service codes. The alleged upcoding, say U.S. attorneys, resulted in the falsification of claims made to federal health care programs between 1992-95.

McKean argues, however, that the company's coding practices were accurate. His attorneys also contend that the time period in question occurred during an "educational window" when coding practices were in a state of flux.

Upcoding is the industry term for falsely representing that doctors' services rendered were at a level higher and more costly than services that patients actually received. McKean's company submitted claims for coverage to Medicare and other health care programs using codes established in part by the Health Care Financing Administration.

Under the False Claims Act, the government is entitled to triple the damages for each violation in addition to civil penalties equaling up to $10,000 for each violation. Whether $1 billion in damages is constitutional is an issue raised by the defense.

From 1992-95, Emergency Physicians submitted as many as 12 million claims, the Department of Justice estimates. Audits conducted on 1,300 claims during that time demonstrated falsification, the government argues.

McKean, a graduate of the University of Oklahoma College of Medicine, testified Friday that he started Emergency Physicians in 1983 after legislation prohibited the combined billing of physicians' services and facility charges. …

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