In a tale as old as time, another physician’s office has opted to settle with the federal government after facing allegations of fraudulent Medicare billing. Under the False Claims Act, it is considered unlawful for a doctor to submit invoices for repayment to healthcare agencies like Medicare or Medicaid for services that were either never rendered, or were rendered at a reduced rate. In order to be liable under the FCA, the defendant must have knowingly submitted invoices in order to defraud the government. The FCA does not cover accidents or negligence – however, those incidents may be punishable under other federal or state statutes. In this case, however, the defendant chose to settle the matter, without admitting liability, for three-quarters of a million dollars and submission to a three-year integrity agreement.
U.S. ex rel. Gavin v. Sarasota Pain Associates, P.A. and Steven Y. Chun, M.D.
The case against Dr. Chun and his Sarasota-based pain management clinic began upon the filing of a whistleblower lawsuit filed by two former nurses in the clinic. According to allegations, Dr. Chun made it office practice to send bills to Medicare for office visits with patients that never occurred. More specifically, between 2006 and 2011, Dr. Chun allegedly submitted invoices for office visits at the highest level of reimbursement – which entails a complex, comprehensive office visit for a patient with compound issues. In fact, these patients visited Dr. Chun for routine office procedures that did not require a comprehensive exam and were reimbursed separately by Medicare. In other words, the examinations claimed on the invoices never actually occurred.
Responses to the Qui Tam Lawsuit
The relators in this case are set to receive up to 30 percent of the amount recovered by the federal government and were highly pivotal in helping federal authorities uncover the details of this fraudulent scheme. According to counsel for both nurses, “[The relators] performed a great service to Florida residents….The conduct in this case was a serious threat to public health and patient safety. The courageous actions of these whistleblowers helped bring to an end deplorable conduct that hurt patients and their families for no reason other than greed.”
The government reiterated its aggressive anti-fraud position by stating, “This case should send a message that we will not tolerate this kind of healthcare fraud in the Middle District of Florida.” An investigative agent with the Department of Health and Human Services stated that taxpayers can “[c]ount on my agency to aggressively pursue cases, whether the target is a large corporation or a single provider….Besides a significant payment, Dr. Chun has agreed to let an independent organization review his claims for three years and then report to the government.”
Healthcare Fraud Affects Us All
Florida is one of the largest states in terms of Medicare enrollees, primarily due to its significant retiree and senior citizen population. However, Medicare fraud can occur anywhere and the government relies on whistleblowers like you to raise claims and alert us all when doctors and hospitals are engaging in unfair kickbacks or billing schemes. If you are aware of healthcare fraud, contact Berger & Montague today.