Nason Medical Settles False Claims Act Allegations for $1 Million

Hot on the heels of the record-breaking fiscal year 2014, the U.S. government continues to pursue and prosecute costly and wasteful healthcare fraud. In today’s case, we explore the facts of a situation occurring in the South Carolina-based Nason Medical Center. The center, located in Charleston, is alleged to have committed various acts of fraud against Medicare, Medicaid, and TRICARE in its treatment of patients.

According to the press release issued by the Department of Justice, the case was commenced by two former employees of Nason Medical Care, one of which is alleged to have lost his job as a result of coming forward with allegations. The relators are set to share a reward of $184,000 as a result of their willingness to come forward and expose the ongoing healthcare fraud scheme.

Details of the case against Nason Medical Care

The facts of the case involving Nason are relatively familiar within the context of healthcare fraud. The center treats a significant number of patients enrolled in federal healthcare programs and is therefore required to adhere to certain practices and protocols in its treatment of these patients. These conditions include, inter alia, ensuring that the services and treatments provided are medically necessary and are billed for in an accurate manner.

First, Nason is alleged to have billed for patient interactions with a physician when, in fact, the center was using physician’s assistants to meet with patients and gather information. At best, this is a wasteful exercise in overbilling the government. At worst, this practice could quickly lead to problems and risk for patients in need of a skilled physician’s services to address their various needs.

Second, Nason is alleged to have engaged in fraudulent practices with regard to its laboratory testing and CT scans. Specifically, the center submitted claims for diagnostic laboratory tests that were either not necessary or not ordered by a physician. The center also billed for CT scans, which emit potentially harmful radiation, that were not medically indicated. As well, Nason is alleged to have allowed an unlicensed individual perform radiological services in stark violation of federal and state regulations.

Finally, the relators claimed that Nason was administering inexpensive tetanus vaccines to patients and subsequently billing for a considerably more expensive brand or variety of the same drug.

Government response

According to the U.S. Attorney’s Office:

“Health care fraud is a very high priority in this office. We have shifted our office resources by trebling the number of attorneys dedicated to address civil fraud cases….This case is particularly egregious because it involves allegations of profiting by exposing patients to unnecessary radiation in the CT scans.”

The Department of Health and Human Services also commented, stating:

“When health care providers order medically unnecessary procedures such as CT scans and submit other improper claims just to boost profits, they threaten both the health of their patients and the financial integrity of the Medicare and Medicaid programs… In an effort to ensure Nason Medical’s egregious billing history is not its future, the company agreed to a rigorous five-year Corporate Integrity Agreement we crafted to hold them accountable.”

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