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Date: 12-21-2021
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Court: United States District Court for the Western District of Texas (McLennan County)
Plaintiff's Attorney: United States Attorney’s Office
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Description: Waco, Texas civil litigation lawyers represented Defendants accused of violating the false claims act by overbilling federal healthcare programs.
The United States’ allegations arise from IPA and CTDSC’s submission of claims to Medicare, Medicaid, and TRICARE for facet joint injections, transforaminal injections, and radiofrequency ablation procedures. The United States contends that the defendants billed for more units or levels of these procedures than they performed. For example, the United States alleges that even when a patient received only a single injection, IPA and CTDSC would sometimes bill the government as though the patient had received two or three injections, thereby increasing the amount paid for the procedure.
“We will not allow health care providers to enrich themselves at taxpayer expense,” said U.S. Attorney Hoff. “We are grateful to our partners at the Department of Health and Human Services Office of Inspector General, the Defense Criminal Investigative Service, and the Civil Medicaid Fraud Division of the Office of the Attorney General of Texas for their assistance in obtaining this significant recovery.”
“Health care providers who try to boost their profits by overbilling federal health care programs will be held accountable for their actions,” said Special Agent in Charge Miranda L. Bennett of the Department of Health and Human Services Office of the Inspector General. “In coordination with our law enforcement partners, our agency will continue to safeguard critical health care programs from such schemes.”
“The Department of Defense Office of Inspector General, Defense Criminal Investigative Service (‘DCIS’) and our law enforcement partners diligently investigate allegations of fraud against individuals or companies attempting to take advantage of the military healthcare system, known as TRICARE,” said Special Agent in Charge Michael Mentavlos, DCIS Southwest Field Office. “Today’s outcome reflects DCIS’s steadfast commitment to protect our Warfighters and their families and hold accountable those who perpetrate the fraud.”
The civil settlement of these allegations includes the resolution of claims brought under the qui tam provisions of the False Claims Act by Susan Edwards. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. The qui tam case is captioned United States and Texas ex rel. Edwards v. Integrated Pain Associates, et al., 5:15-cv-00315-FB (W.D. Tex.).
Assistant U.S. Attorney Thomas Parnham represented the United States in this matter.
The claims resolved by the settlement are allegations only. There has been no determination of liability.
Outcome: Integrated Pain Associates, PLLC (“IPA”), a pain clinic headquartered in Killeen, and Central Texas Day Surgery Center, LLC (“CTDSC”), an affiliated ambulatory surgery center, agreed to pay the United States and the State of Texas $836,702.88 to settle the claims made against them.
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