Bloom Care LLC, which operated urgent care clinics across Idaho and New Mexico during the COVID‑19 pandemic, has paid $3 million to resolve allegations under the False Claims Act. According to the U.S. Attorney’s Office for the District of Idaho, Bloom Care—along with its owners—submitted false claims to federal healthcare programs by performing medically unnecessary tests and exaggerating services provided.
Allegations at a Glance
- Unnecessary Testing: The company allegedly billed for strep and flu tests on asymptomatic patients, exploiting pandemic-related fears to generate revenue.
- E/M Upcoding Services: Bloom Care is accused of upcoding—billing for higher-level evaluation and management (E/M) services than what was medically necessary, often without the clinical complexity to justify the codes used.
These practices triggered scrutiny from the Department of Justice, HHS-OIG, VA OIG, and the Idaho Department of Health and Welfare, resulting in a costly settlement and reputational harm.
Why It Matters: Protecting Your Practice in a Complex Regulatory Climate
As healthcare regulations grow more complex—particularly around billing, coding, and pandemic-era reimbursements—healthcare providers must tread carefully to avoid unintentional violations. Settlements like Bloom Care’s highlight how even administrative or documentation oversights can result in major financial consequences.
How a Reimbursement Attorney Can Safeguard Your Practice
Hiring a reimbursement attorney is not just a reactive step for when you’re under investigation—it can be a proactive, strategic investment in the long-term health of your medical practice. Here’s how:
- Ensure Billing Compliance
Reimbursement attorneys review your billing, coding, and documentation practices against federal and state regulations. This helps reduce your risk of fraudulent billing, upcoding, or improper bundling, which can easily trigger audits or whistleblower claims.
- Audit-Readiness and Response
They prepare you for routine or surprise audits by federal payers (like Medicare and Medicaid), helping you maintain organized, compliant documentation. If an audit or overpayment inquiry does occur, they manage the legal response—potentially saving thousands or millions in penalties.
- Contract and Payer Agreement Review
Reimbursement attorneys evaluate contracts with commercial insurers and government payers, ensuring the language protects your interests, properly defines medical necessity, and aligns with your billing operations.
- Training & Internal Policy Development
They can create internal policies and conduct staff training to make sure clinical, billing, and administrative teams understand compliance standards and reimbursement rules—a strong preventive defense against inadvertent missteps.
- Strategic Advice on New Services or Expansion
Before launching a new line of service (e.g., urgent care, telehealth, concierge medicine), reimbursement counsel helps you structure offerings in a compliant, financially sustainable way.
Final Takeaway
The $3 million Bloom Care settlement is a clear reminder: in the eyes of the government, intent isn’t always a defense. Whether errors are deliberate or accidental, medical practices are held accountable. Having a reimbursement attorney in your corner provides a strategic buffer against these risks—ensuring your growth doesn’t come at the cost of compliance.
