The DOJ Prosecutes All Levels of Healthcare Fraud

vladimir-kudinov-71455-copy-300x241There is a misconception that the U.S. Department of Justice (DOJ) is mainly interested in health care fraud and violations of the False Claim Act (FCA) from large corporations like major insurers or pharmaceutical manufacturers. However, this is not true. The DOJ is on a mission to uncover health care fraud at all levels of care, including with individual physicians, local hospitals, regional insurers, and multi-national businesses. This is evidence by two recent DOJ announcements regarding settlements with a family practice chain in South Carolina and a hospital operator in New York.

South Carolina Family Medicine Centers

The Family Medicine Centers of South Carolina LLC (FMC) agreed to pay the U.S. $1.56 million to resolve allegations of FCA violations. FMC is a physician-owned chain of five, previously six, medical practices located in Columbia, South Carolina, and the surrounding area. FMC’s principal owner and chief executive officer Dr. Stephen F. Serbin and FMC’s former laboratory director Victoria Serbin will pay $443,000 to personally resolve allegations of FCA violations.

A qui tam lawsuit against FMC and the Serbins brought by a former physician employee, Dr. Catherine A. Schaefer, alleged that they submitted claims that violated the Stark Law. This law prohibits physicians from billing Medicare for certain services that were ordered by physicians who have a financial relationship with the clinic. FMC had an incentive compensation plan that paid the clinics’ physicians a percentage of the value of lab or other diagnostic tests that they ordered through FMC, which FMC billed to Medicare. The lawsuit also alleged that FMC and the Serbins filed claims with Medicare and TRICARE for medically unnecessary lab services by creating custom lab panels that were not necessary for routine analysis and ordering these panels to be tested with a specific frequency and not based on medical need.

The whistleblower, Dr. Schaefer, is set to receive $340,510 from the settlement.

New York Hospital Operator

MedSys Health Network Inc., which owns and operates two hospitals in Queens, New York, will pay the U.S. $4 million. This settlement is a resolution of a qui tam suit brought by Dr. Satish Deshpande. In the lawsuit, Deshpande alleged the defendants submitted false claims to Medicare for services provided to patients who were referred by physicians with whom MedSys had improper financial relationships with. Allegedly, MedSys had improper compensation and office lease arrangements with certain physicians that violated the Stark Law.

Dr. Deshpande will receive $600,000 for his role as the relator in the FCA suit.

Do You Have Information About Health Care Fraud in San Francisco?

If you are medical professional in the Bay Area and you believe you have information about a physician, medical practice, or other health care entity filing fraudulent claims with Medicare or Medi-Cal or causing false claims to be filed, contact our experienced health care fraud lawyers at Brod Law Firm today. If you have private information about health care fraud, you may have the right to move forward with a qui tam suit. If the government is able to reach a settlement or obtain a jury award against the other parties, you may benefit from a percentage of the government’s financial recovery.

You can contact us online or call (800) 427-7020 to schedule a free consultation.

(image courtesy of Vladimir Kudinov)