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United States of America v. Dr. Ashok Jain, Psychiatric Solutions, P.C. Longview Psychiatric Center, P.L.L.C. and Loview Psychiatric Center, L.P.
Court: United States District Court for the Southern District of Texas (Harris County)
Plaintiff's Attorney: United States Attorney’s Office in Houston
Description: Houston, Texas commercial litigation lawyers represented Defendants accused of violating the False Claims Act by improperly billing Medicare for unnecessary brain stimulation treatments.
Dr. Ashok Jain and companies known as Psychiatric Solutions P.C., Longview Psychiatric Center PLLC and Longview Psychiatric Center LP knowingly and willfully submitted, or caused the submission of, false claims to Medicare. The allegations included intentionally pressuring patients to accept unnecessary medical treatments and billing for those treatments, falsifying treatment records and billing Medicare for worthless services and services they did not provide.
“This office will actively pursue and prosecute those who take advantage of our aged population and those who seek psychiatric care and counseling,” said Hamdani. “It is particularly egregious when those citizens who seek care are given unnecessary treatment and not the treatment that would benefit them. Providers who participate in federally funded programs like Medicare have a responsibility to the public to provide legitimate, safe care and treatment.”
The investigation began when two individuals who worked at the Psychiatric Solutions Longview clinic filed a qui tam, aka whistleblower, lawsuit under seal July 15, 2021.
During their terms of employment, they allegedly witnessed patients being pressured to accept unnecessary medical treatments as well as the falsification of treatment records and billing Medicare for worthless services or services the clinic did not provide.
Jain and the clinics had allegedly submitted claims for payment to Medicare for Transcranial Magnetic Stimulation (TMS) procedures that were not performed, routinely administered TMS treatments unnecessarily and absent a valid medical purpose and improperly billed Medicare for reimbursement of those treatments. They also billed Medicare for physician assessments when the physician did not see the patient or supervise the TMS session.
The complaint indicated the fraudulent conduct continued until the business was sold in April 2022.
“At the least, health care practitioners are expected to furnish services that are appropriate for their patients and to bill accurately. Providers believed to violate those basic requirements are principal targets of our investigative efforts,” stated Acting Special Agent in Charge Korby Harshaw with the Department of Health and Human Services Office of Inspector General (HHS-OIG). “Coordinating with our law enforcement partners, HHS-OIG proudly carries out our mission to protect federal health care patients and programs from exploitation.”
“Billions upon billions of taxpayer dollars are stolen by healthcare fraudsters each year,” said FBI Houston Special Agent in Charge James Smith. “FBI Houston’s dedicated team of healthcare investigators, analysts and forensic accountants work alongside our valued law enforcement partners every day to identify these criminals, hold them accountable and protect our nation from pervasive fraud schemes which enrich criminals at the expense of hardworking, honest Americans.”
Under the False Claims Act, a private party known as a relator can file an action on behalf of the United States and receive a portion of the recovery. In this case, the relators will receive a total of $300,000.
DHHS-OIG and FBI conducted the investigation. Assistant U.S. Attorney Jill Venezia handled the matter.
Outcome: Settled for $3 million.