Florida Physician Allegedly Submitted Exaggerated Bogus Claims to Medicare, Whistleblower Case Leads to $750,000 Settlement, Parker Waichman LLP Reports

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The United States Department of Justice just announced a $750,000 settlement agreement involving a Florida physician who submitted bogus medical claims to the Medicare system.

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When physicians defraud the government, they are defrauding taxpayers, as well. Appropriate submission of medical diagnoses is important to taxpaying citizens, the government, and medical programs.

A physician in Florida just agreed to a $750,000 settlement over allegations he and his pain management clinic billed Medicare for clinical services that were entered as being complex, which meant they were more costly than they were. In some cases, billing was allegedly submitted for services that were never performed, according to a U.S. Department of Justice announcement. The case was filed March 21, 2011, and is U.S. ex rel. Gavin et al. v Sarasota Pain Associates PA et al., case number 8:11-cv-00583, in the U.S. District Court for the Middle District of Florida.

Dr. Steven Chun and his clinic, Sarasota Pain Associates PA, was originally located in Sarasota, Florida then moved to Bradenton, Florida. Between 2006 and 2011, Dr. Chun and Sarasota Pain Associates PA, allegedly incorrectly billed Medicare at the highest possible rate of billing, according to the United States attorney for the Middle District of Florida. The physician and his clinic claimed to have completed thorough examinations for complex medical issues, Law 360 reported.

Dr. Chun utilized actual patient names, allegedly charging for scheduled procedures and examinations that were never conducted, according to a The Herald Tribune report.

In fact, the patient histories involved concerned routine, scheduled clinic procedures that did not call for extensive exams as well as procedures that allegedly never took place, but for which Medicare reimbursement was made. Both issues are violations of the False Claims Act, the Department of Justice announced.

Allegedly, these visits were typically short and involved refilling an implanted pain medication pump. Refilling was usually handled by nurses, with the doctor checking in. In this type of a case, Medicare might be billed for a pain relief injection that did not occur, the Law 360 report indicated.

“When physicians defraud the government, they are defrauding taxpayers, as well. Appropriate submission of medical diagnoses is important to taxpaying citizens, the government, and medical programs,” said Gary Falkowitz, Managing Attorney at Parker Waichman LLP. “It is also this sort of bogus activity that creates an ongoing trend of illegal activities that puts innocent employees in difficult, untenable work situations,” Mr. Falkowitz added.

U.S. Attorney, A. Lee Bently III, called the settlement a “significant achievement” for the civil division of the Department of Justice (DOJ), saying that the Department exerted significant determination in the way in which it went after a “troubling pattern of billing fraud,” according to the Law 360 report. "This case should send a message that we will not tolerate this kind of health care fraud in the Middle District of Florida,” Bentley said.

The DOJ’s civil division, the U.S. Attorney’s Office (USAO)’s office, and the U.S. Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) all collaborated in the probe, along with Christopher B. Dennis, special agent in charge of HHS OIG’s Miami regional office. Those committing fraud, according to Special Agent Dennis, could rely on his agency to "aggressively pursue cases, whether the target is a large corporation or a single provider,” according to the Law 360 report.

A tentative agreement was agreed to in December and followed a March 2011 whistleblower lawsuit brought by so-called “qui tam relators,” Cathia Gavin and Penelope Thomas. Ms. Gavin and Ms. Thomas are nurses who previously worked for Dr. Chun. The DOJ indicated that both women would receive a share of the settlement, the Law 360 report indicated.

The Tampa Bay Business Journal reported that the allegations originated with a lawsuit that had been filed in Tampa federal and was filed under the whistleblower provisions of the False Claims Act. The Act provides private citizens with the ability to sue on behalf of the federal government, receiving a share of any recovery.

In November 2012, the federal government intervened, and claimed in its intervenor complaint, that Dr. Chun and his clinic were allegedly routinely billing Medicare with billing codes meant for high level visits—complex procedures—when patients were receiving routine care that did not qualify as a high level visit, according to the Law360 report

Parker Waichman LLP supports efforts to protect whistleblowers from retaliation by their employers and continues to offer free legal evaluations to those courageous individuals who believe their company may be involved in wrongdoings. If you believe that your company is involved in illegal activities, please visit the firm’s Whistleblower page at yourlawyer.com or call 1-800-LAW-INFO (1-800-529-4636).

Parker Waichman LLP
Gary Falkowitz, Managing Attorney
1+ (800) LAW-INFO
1+ (800) 529-4636

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Gary Falkowitz
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