From Test to Testimony: How a patient blew the whistle on CityMD’s $12 million COVID scam.
The United States spent a lot of money responding to COVID. Like, a lot a lot. How much? How about $4.4 trillion. If COVID spending was a country, it would be the fourth largest country in the world by GDP, beating out Japan, India, and every European country except Germany.
Some of that COVID money went to fund health care programs for individuals without insurance. You know, the most vulnerable who needed a little extra help to cope with the effects of an unprecedented, worldwide pandemic. So, the United States allocated $24.5 billion to the Health Resources and Services Administration (“HSRA”) for testing uninsured individuals for COVID-19, treating uninsured individuals with a COVID-19 diagnosis, and administering COVID-19 vaccines to uninsured individuals.
Good deal for any provider: if the patient has insurance, they could bill insurance. If they didn’t have insurance, they could bill HSRA. Either way, the provider would get paid.
But that deal just wasn’t enough for CityMD. Even for patients who had insurance, they would bill the HSRA, presumably because the HSRA paid more. Like Josh Brolin’s character in Wall Street: Greed Never Sleeps, it just wanted more. Ok for finance, not when you’re billing the government.
The scheme: Patients would go to CityMD to get tested for COVID. During the intake process, they would let CityMD know whether they had insurance. If they did, they would provide their insurance information. If not, they wouldn’t. But either way, CityMD would bill the government.
What would they do with the insurance information that they received from the patient, aka , the evidence that they were submitting a false claim? Well, they would just act like it never happened:
And they weren’t very subtle about it. They had no problems telling patients, in this case, the relator, that they were just going to delete his insurance information. In some instances, CityMD still had the patients insurance provider on file. Uh, getting and then keeping the incriminating evidence, that’s just a really bad way to do fraud.
The penalty: $12,037,109. CityMD voluntarily returned $7,022,522 to the United States and paid an additional $5,014,587.
The whistleblower: Stephen Kitzinger was a patient who blew the whistle. He got a COVID test and disclosed that he was insured by entering both his primary and secondary insurance information on CityMD’s patient information portal. When Mr. Kitzinger checked his information in CityMD’s patient portal, he discovered that CityMD listed him as uninsured. In his own words: “There was no reason to bill the government’s uninsured program for people like me, who are fully insured. That wasted limited government money, misused taxpayer dollars, and potentially deprived those without insurance of necessary testing and care,” said Stephen Kitzinger, the whistleblower in the case. “It angered me and clearly demonstrated what is wrong with the for-profit healthcare system.”
Really goes to show that anyone can be a whistleblower.
Whistleblower reward: Under the qui tam provision of the False Claims Act, a private party may file an action on behalf of the United States and receive a portion of the recovery, typically between 15-30%. As the relator, Mr. Kitzinger will receive $2,046,308 as his share of the recovery
If you think you’ve observed fraud or misconduct, we can evaluate your options. Vivek Kothari is a former federal prosecutor who represents whistleblowers. For a free consultation, contact Vivek by email, Signal, or fill out the contact form.