Billing Fraud Recent Developments

Assistant Attorney General Discusses DOJ Civil Fraud Priorities At Qui Tam Conference

Recently, U.S. Acting Assistant Attorney General Brian M. Boynton spoke at the Federal Bar Association Qui Tam Conference about the False Claims Act enforcement priorities. Boynton spoke about the Justice Department’s commitment to combatting fraud targeting senior citizens. He explained that the Department has used the False Claims Act to resolve matters with nursing facility chains and rehabilitation contractors for “knowingly providing or billing for medically unnecessary rehabilitation therapy services.” Further, he provided that the Department has open investigations across the country focusing on nursing homes that are providing “deficient care to our nation’s seniors.”

Oglethorpe Billing Fraud Settlement

In March 2021, the company Oglethorpe Inc. and three of its Ohio treatment facilities agreed to pay $10.25 million to settle False Claims Act allegations. The settlement includes the resolution of claims filed under the qui tam or whistleblower provisions of the False Claims Act. Specifically, the claims alleged that the company improperly provided free long-distance transportation to patients and admitted patients who did not require inpatient psychiatric treatment. These fraudulent actions resulted in the submission of false claims to the Medicare program. Speaking on the settlement, Acting U.S. Attorney Vipal J. Patel for the Southern District of Ohio said, “[s]ubmitting false claims by billing for unnecessary inpatient psychiatric hospitalizations is not only inappropriate—it’s illegal.” He went on to say, “[t]his settlement shows that the United States will hold accountable those who seek to profit by flouting proper standards of medical practice and appropriate review and submission of Medicare billings.”

Cardiologist Dinesh Shah False Claims Act Settlement

Another recent False Claims Act settlement involves an Oakland County Cardiologist, Dinesh M. Shah, and his practice, Michigan Physicians Group. Shah and his practice have paid the United States $2 million to resolve allegations that they violated the False Claims Act by “knowingly billing federal healthcare programs for diagnostic testing that was either unnecessary or not performed.” The settlement results from the billing of unnecessary testing from programs including Medicare, Medicaid, and TRICARE. Lamont Pugh III, Special Agent in Charge, commented, “[p]hysicians commit to providing and billing for only medically necessary services when they choose their profession and participate in federally health care programs.” He further stated, “[t]o deviate from that commitment and potentially place their patient’s health and safety at risk as well as limited tax payers resources is unacceptable. The OIG will continue to work with our federal, state and local partners to ensure that patients and tax payer dollars are protected.”

At Price Armstrong, we have extensive experience litigating medical billing fraud cases under the False Claims Act. We work hard to protect whistleblowers every step of the way under the False Claims Act while maximizing their recovery. Contact us for a free initial consultation and review of your case.