Business ProfileforBluestone Physician Services Florida, LLC

Bluestone Physician Services of Florida LLC, Bluestone Physician Services, P.A. and Bluestone National LLC, operating in Florida, Minnesota and Wisconsin, have agreed to pay $14,902,000 to resolve allegations that they knowingly submitted claims for certain Evaluation and Management codes for services related to the management of chronic care patients in assisted living and other care facilities that were not provided in conformity with applicable Medicare, Medicaid and TRICARE requirements. 

The settlement resolves allegations that, during the period from Jan. 1, 2015, through Dec. 31, 2019, Bluestone knowingly submitted claims for two Evaluation and Management codes, the domiciliary rest home visit code for established patients, that did not support the level of service provided. The federal government’s share of the settlement is $13,842,482 and $1,059,518 will be paid to the States of Florida and Minnesota.

In connection with the settlement, Bluestone has entered into a five-year Corporate Integrity Agreement (CIA) with HHS-OIG, which requires Bluestone, among other obligations, to establish and maintain a compliance program meeting certain requirements and to submit to an Independent Review Organization’s review of Bluestone’s Medicare claims to determine whether such claims were medically necessary, appropriately documented, and correctly coded.

The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Lisa Loscalzo, the former General Manager for Bluestone’s Florida market. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. The qui tam case is captioned U.S. ex rel. Loscalzo v. Bluestone Physician Services of Florida, Bluestone Physician Services, P.A., Bluestone National, LLC et al., 20-cv-295-FtM-38NPM (M.D. Fla). The civil settlement also includes the resolution of related allegations investigated by the U.S. Attorney’s Office for the District of Minnesota. Ms. Loscalzo will receive $2,831,380 in connection with the settlement.

The claims resolved by the settlement are allegations only. There has been no determination of liability.