CityMD — HRSA Uninsured Program Claims
CityMD Pays Over $12 Million for Improper HRSA Uninsured Program Billing
Source: U.S. Department of Justice
TL;DR: CityMD Pays Over $12 Million for Improper HRSA Uninsured Program Billing This case resulted in a $12 Million resolution and demonstrates the impact of whistleblower protections in recovering funds from fraud.
Summary
CityMD-related entities agreed to pay $12,037,109 to resolve DOJ allegations that false claims were submitted for COVID-19 testing to HRSA's Uninsured Program. DOJ alleged that, from February 4, 2020 through April 5, 2022, CityMD billed (or caused billing) to the Uninsured Program for individuals who had insurance coverage, including by failing to adequately confirm insurance status and, in some instances, issuing lab requisitions that erroneously indicated patients were uninsured—leading outside laboratories to submit claims to HRSA. DOJ also noted CityMD received credit for voluntary disclosure, cooperation, and remediation, and that the settlement resolved a qui tam action.
Our Take
Uninsured Program cases often arise from front-end intake and billing logic: what the system defaulted to when information was missing, and whether staff were trained (or pressured) to keep throughput high. The strongest internal records tend to be mundane: eligibility workflows, screenshots or configuration rules, audit trails showing what insurance data existed at the time of claim submission, and communications about "fixing" error rates. If you saw uninsured status treated as a billing shortcut, preserve the workflow evidence—what the clinic knew, when it knew it, and what it did next.
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Notice
The summaries above are based on publicly available information released by the U.S. Department of Justice and are provided for informational purposes only. They do not constitute legal advice, investigative findings, or allegations by Disclosure Strategy. Our commentary reflects general, experience-based observations about how False Claims Act matters commonly arise and is not a statement about any party's liability.