HOUSTON – A 46-year-old local chiropractor and her medical group have been named in a civil suit under the False Claims Act alleging fraudulent billing, announced Acting U.S. Attorney Jennifer B. Lowery.

Suhyun An owns and manages Campbell Medical Group PLLC and Johnson Medical Group PLLC dba Campbell Medical Clinic in the Spring Valley area of Houston.

The civil complaint, filed today, alleges An fraudulently obtained over $3.9 million from the Medicare and TRICARE programs by billing for the implantation of neurostimulator electrodes. These are surgical procedures usually requiring use of an operating room, and Medicare pays thousands of dollars for this procedure, according to the complaint.  

The complaint alleges that neither An nor her clinic’s employees performed surgery. Instead, they allegedly applied inexpensive devices used for electro-acupuncture. This procedure involves inserting needles into patients’ ears with a neurostimulator taped behind the ears with an adhesive, according to the complaint.

The lawsuit alleges nurse practitioners working for An learned how to apply the devices by watching YouTube videos and participating in trainings with sales representatives.

The complaint alleges An knew the devices were not billable or recklessly disregarded that fact. She allegedly read specific guidance from a Medicare contractor stating Medicare did not cover the devices because they only provided acupuncture. The suit further claims she ignored emailed warnings from employees and outside billing companies including warnings that the devices were being labeled as “possible fraud.”

The Department of Health and Human Services – Office of Inspector General and Defense Criminal Investigative Services assisted with the investigation. Assistant U.S. Attorney Brad Gray is handling the matter.

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Care Initiatives, a Texas corporation with a home office in West Des Moines, Iowa, has agreed to repay the United States $214,200 to resolve claims the United States was entitled to restitution for the federal share of Medicaid funds the facility received for an approximately 10 week period while residents at Dubuque Specialty Care, a Care Initiatives facility, were suffering from or testing positive for COVID-19. The United States alleged that repayment of these funds was warranted due to Dubuque Specialty Care’s practices surrounding COVID-19 infections, including the facility’s procedures and criteria for screening symptomatic employees.

Care Initiatives cooperated during the investigation and did not admit to any liability as part of the settlement agreement.

“Our office expects that recipients of federal healthcare funds take appropriate steps to maintain beneficiary safety, to protect our district’s most vulnerable residents, and to ensure their practices comport with recognized standards, especially during this unprecedented time,” said Acting United States Attorney Sean R. Berry.

“Being a healthcare provider in the Medicare and Medicaid programs is a privilege, not a right. It is incumbent upon these providers to protect the safety of beneficiaries under their care, especially during this pandemic,” said Special Agent in Charge Curt L. Muller of Department of Health and Human Services Office of Inspector General. “Our investigators, working closely with our law enforcement partners, will continue to thoroughly investigate allegations of substandard safety practices.”

Individuals with direct knowledge of facilities in the Northern District of Iowa failing to comply with recognized standards and procedures during the pandemic are encouraged to report any such failures to the appropriate authorities, including the United States Attorney’s Office. The case was handled by Assistant United States Attorney Jake Schunk and investigated by the Department of Health and Human Services Office of Inspector General.

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Dr. Feng Qin Agrees to Pay $800,000, Admits Misconduct, and Receives Four-Year Ban from Participating in Federal Healthcare Programs

Audrey Strauss, the United States Attorney for the Southern District of New York, and Scott Lampert, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General’s (“HHS-OIG”) New York Region, announced today that the civil and criminal healthcare fraud cases against FENG QIN, M.D. (“QIN”), a vascular surgeon, and his medical practice QIN MEDICAL P.C. (“QIN MEDICAL”) have been resolved. QIN, who practiced in Lower Manhattan and Far Rockaway, Queens, was criminally charged in December 2018 with fraudulently billing Medicare for vascular surgery procedures performed on end-stage renal disease (“ESRD”) patients that were not medically reasonable and necessary or covered under Medicare rules; the United States also filed a civil healthcare fraud complaint against QIN and QIN MEDICAL in December 2018.

Under the civil settlement approved today by U.S. District Judge Laura Taylor Swain, QIN and QIN MEDICAL agreed to a pay $783,200 to the United States. The State of New York is expected soon to enter into an additional settlement with defendants in the amount of $16,800, for a total recovery of $800,000. The amount is based on the Office’s assessment of the defendants’ ability to pay based on the financial information they provided. As part of the settlement, QIN and QIN MEDICAL admitted and accepted responsibility for conduct alleged by the Government in its civil complaint as further described below. QIN previously paid $150,000 to settle a prior civil fraud lawsuit filed against him and his previous employer for engaging in fraudulent billing practices during the time period 2010 through 2012.

QIN also entered into a Voluntary Exclusion Agreement with HHS-OIG, which prohibits him from participating in Medicare and other federal healthcare programs for four years. This is in addition to the more than two years he has been so excluded since his arrest, as a condition of his bail. The Government has agreed to defer QIN’s criminal prosecution for a period of one year, after which time it will seek to dismiss the charges if QIN abides by the terms of the deferred prosecution agreement.  

Manhattan U.S. Attorney Audrey Strauss said: “For several years, Dr. Qin performed interventional vascular procedures on patients with end-stage renal disease without any documented clinical justification. As a repeat offender, Dr. Qin now faces a lengthy suspension from participating in federal healthcare programs and must make a hefty monetary payment. This Office will continue to hold unscrupulous medical providers accountable when they perform and bill the Government for medically unnecessary procedures.”

HHS-OIG Special Agent in Charge Scott Lampert said: “By billing Medicare for medically unnecessary procedures, Dr. Qin needlessly compromised patient care and victimized taxpayers. Our agency will continue to hold medical professionals accountable, while protecting the federal health care programs intended for those that depend on them for critical services.”

According to the indictment and the Government’s civil complaint:

Patients with ESRD who are receiving dialysis may require vascular access surgical procedures, such as fistulagrams, where dye is injected into the patient’s vein or artery to visualize blood flow, and percutaneous transluminal angioplasties, in which wires and balloons are inserted into blood vessels that have narrowed in order to restore blood flow. However, as Medicare billing guidelines made clear, it is not reasonable and necessary for physicians to bill the program for fistulagrams and angioplasties unless the patient has specific and documented clinical problems, such as significant difficulty receiving dialysis properly.

The patients at QIN’s medical practice primarily consisted of ESRD patients undergoing dialysis treatment. During the relevant period, from 2015 to 2016, QIN routinely scheduled patients for fistulagrams and angioplasties three months in advance, and performed fistulagrams and angioplasties on these patients as a matter of routine, regardless of whether there was a justifiable clinical reason to do so. Furthermore, on multiple occasions he misrepresented the medical conditions of patients in their medical records to make it seem as if they suffered from symptoms that would warrant the procedures when they did not. QIN MEDICAL then unlawfully billed and received payment from Medicare for these procedures, which were excluded from Medicare coverage, as QIN knew.

As part of the civil settlement, QIN and QIN MEDICAL admit, acknowledge, and accept responsibility for the following conduct:

• QIN often routinely scheduled, and actually saw, ESRD patients approximately every three months, regardless of their medical need.

• QIN treated many of his ESRD patients with fistulagrams and angioplasties. The symptoms documented in the medical records, including the records of the dialysis center and the treating nephrologist, were insufficient to justify these treatments for numerous ESRD patients.

• QIN knew that in the absence of a documented clinical justification, Medicare would not pay for fistulagrams or angioplasties. Nevertheless on numerous occasions, QIN MEDICAL sought and received reimbursement from Medicare for these treatments without the required documented clinical justification.
• The allegations of fraud stated in the civil complaint were first brought to the attention of federal law enforcement by a whistleblower who filed a lawsuit under the False Claims Act.

The criminal case is being handled by the Office’s General Crimes Unit. Assistant United States Attorneys Jean-David Barnea, Michael Krouse, and Alexander Li are in charge of the criminal prosecution. The civil case is being handled by the Office’s Civil Frauds Unit, and Assistant United States Attorney Barnea is in charge of the matter.

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Dr. Ashish Pal, a cardiologist based in Orlando, Florida, has paid $6.75 million to resolve allegations that he violated the False Claims Act by performing medically unnecessary ablations and vein stent procedures.

The settlement resolves allegations that, from Jan. 1, 2013 to Dec. 31, 2019, Dr. Pal knowingly submitted false claims to federal health care programs for medically unnecessary ablations and vein stent procedures. The government alleged that Dr. Pal performed the ablations and stent procedures on veins that did not qualify for treatment under accepted standards of medical practice. Additionally, the government alleged that Dr. Pal made misrepresentations in patient medical records to justify the procedures, including overstating the degree of reflux and diameter of veins, and falsely documenting patient symptoms. The United States also alleged that, in many instances, the ablations were performed either exclusively or primarily by one or more ultrasound technicians outside their scope of practice.

“Physicians are expected to perform procedures only when they have a legitimate medical basis to do so,” said Acting Assistant Attorney General Brian M. Boynton for Justice Department’s Civil Division. “The department will pursue those who waste taxpayer funds and subject patients to unwarranted medical care.”

“Our office is committed to protecting vulnerable patients from those who put financial gain ahead of patients’ needs,” said Acting U.S. Attorney Karin Hoppmann of the Middle District of Florida. “We will continue to hold accountable those who abuse the nation’s healthcare programs at the expense of the taxpayers.”

“The Department of Defense Office of Inspector General, Defense Criminal Investigative Service (DCIS) will continue to lead the way in the dogged pursuit of unethical providers who risk patient health for profit,” said Acting Inspector General Sean O’Donnell for the Department of Defense Office of Inspector General. “Ensuring Force readiness and proper care of our military members and their families are among our top priorities.”

“When physicians enrich themselves by performing medically unnecessary procedures on Medicare and Medicaid beneficiaries, they threaten their patients’ health and divert taxpayer funds meant to pay for necessary care,” said Special Agent in Charge Omar Pérez Aybar of U.S. Department of Health & Human Services Office of Inspector General (HHS-OIG). “We will continue to work hard with our law enforcement partners to ensure that health care providers who engage in such abusive behavior are held accountable.”

“The healthcare providers within the Military Health System are committed to patient satisfaction and take seriously their obligation to ensure great outcomes by providing the highest-quality care,” said Director Lt. Gen. Ronald J. Place, M.D. of the Defense Health Agency (DHA). “We are grateful to the U.S. Department of Justice for working to maintain that trust by ensuring medical providers continue to put their patients’ needs and safety first.”

“The Office of Personnel Management’s Office of the Inspector General (OPM-OIG) is dedicated to investigating providers that prioritize profits over patient well-being,” said Deputy Inspector General Performing the Duties of the Inspector General Norbert E. Vint for the OPM-OIG. “We will continue to work with our law enforcement partners and colleagues at the Department of Justice to safeguard the federal health care programs from fraud.”

To help ensure the alleged abuses outlined in this case do not reoccur, Dr. Pal and Interventional Cardiology & Vascular Consultants, PLC entered a detailed, multi-year integrity agreement with HHS-OIG. This integrity agreement contains training and reporting requirements as well as a quarterly claims review conducted by an Independent Review Organization, with the requirement that the review team includes at least one interventional cardiologist who is board certified. It also contains provisions for stipulated penalties and, possibly, the exclusion from federal health programs such as Medicare and Medicaid in the event of a breach of its terms.

The resolution obtained in this matter was the result of a coordinated effort between the Civil Division’s Commercial Litigation Branch, Fraud Section and the U.S. Attorney’s Office for the Middle District of Florida, with assistance from the Department of Defense Office of Inspector General - DCIS, the FBI, the U.S. Department of Health & Human Services Office of Inspector General and the Office of Personnel Management Office of Inspector General.

The government’s pursuit of this matter illustrates its emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse and mismanagement can be reported to the Department of Health and Human Services, at 800‑HHS‑TIPS (800-447-8477).

This matter was handled by Nicholas C. Perros of the Civil Division’s Commercial Litigation Branch, Fraud Section, and Assistant U.S. Attorney Michael R. Kenneth of the U.S. Attorney’s Office for the Middle District of Florida.

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Walla Walla, WA – Providence Health & Services Washington (Providence) has agreed to pay $22,690,458 to resolve allegations that it fraudulently billed Medicare, Medicaid, and other federal health care programs for medically unnecessary neurosurgery procedures, announced Vanessa R. Waldref, the United States Attorney for the Eastern District of Washington and Bob Ferguson, the Washington State Attorney General. Today’s joint settlement between Providence, the United States, and the State of Washington, which administers Washington’s Medicaid program using a combination of state and federal funding, is the largest-ever health care fraud settlement in the Eastern District of Washington.

Providence is a large health care and hospital system that operates 51 hospitals in seven western U.S. states, including Providence St. Mary’s Medical Center (Providence St. Mary’s) in Walla Walla, Washington. Between 2013 and 2018, Providence St. Mary’s employed neurosurgeons identified in the Settlement Agreement as Dr. A and Dr. B. Providence St. Mary’s paid neurosurgeons based on a productivity metric that provided them a financial incentive to perform more surgical procedures of greater complexity. Between 2014 and 2018, Dr. A was one of the highest producing neurosurgeons in the entire Providence system. Between 2014 and 2017, based on the productivity metric, Providence paid Dr. A between $2.5 million and $2.9 million per year. Today’s settlement resolves allegations that Providence falsely billed Medicare, Washington State Medicaid, and other federal health care programs for deficient and medically unnecessary neurosurgery procedures performed by Dr. A and Dr. B.

“Ensuring that surgical procedures are medically appropriate and properly performed is critical to building safe and strong communities here in the Eastern District of Washington,” said U.S. Attorney Waldref. “Patients with back pain and spinal injury deserve top-notch care from a provider who puts the patient first and is not improperly influenced by how much he can bill for the procedure. Providence’s failure to ensure that Dr. A and Dr. B were performing safe and medically-appropriate surgery procedures, despite repeated warnings, put patients’ lives and safety at serious risk. I am also gravely concerned that Providence’s decision not to report Dr. A or Dr. B to federal or state medical oversight bodies allowed both surgeons to simply resign from Providence and then continue to endanger patients at other hospitals.”

As part of the Settlement Agreement, Providence admitted that, during the time period in which Dr. A and Dr. B were employed at Providence St. Mary’s as neurosurgeons, Providence medical personnel articulated concerns that Dr. A and Dr. B: (1) were endangering the safety of patients; (2) created through their surgeries an excessive level of complications and negative outcomes; (3) performed surgery on candidates who were not appropriate for surgery; and (4) failed to properly document their procedures and outcomes. Providence further admitted that Providence medical personnel articulated additional concerns that Dr. A: (1) completed medical documentation with falsified and exaggerated diagnoses in order to obtain reimbursement from insurance providers; (2) performed surgical procedures that did not meet the medical necessity requirements set by Medicare and other insurance programs; (3) “over-operated”, i.e., performed surgeries of greater complexity and scope than were medically appropriate; and (4) jeopardized patient safety by attempting to perform an excessive number of overly complex surgeries. Finally, Providence admitted that, while it eventually placed both Dr. B and Dr. A on administrative leave in February 2017 and May 2018, respectively, it allowed both doctors to resign while on leave, and did not take any action to report Dr. A or Dr. B to the National Practitioner Data Bank or the Washington State Department of Health.

As part of the settlement, Providence entered into a Corporate Integrity Agreement (CIA) with the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG). The CIA requires, among other things, that Providence implement and maintain a number of quality-of-care and patient safety obligations. Additionally, the CIA requires that Providence retain outside experts to perform annual claims and clinical quality systems reviews.

United States Attorney Waldref further stated, “While Providence’s conduct was extremely troubling, I do want to commend Providence for stepping up, accepting responsibility, taking appropriate and meaningful corrective action, and for fully cooperating with our investigation as well as agreeing to fully cooperate in our ongoing investigations. United States Attorney Waldref continued “I also want to express special appreciation for our close collaboration and partnership with the Washington Medicaid Fraud Control Division and with the whistleblower and his team, as well as the exceptional investigative work performed by HHS-OIG, Office of Personnel Management OIG, and Defense Criminal Investigative Service. We will continue to work closely with our state and federal law enforcement partners and with courageous whistleblowers to hold health care fraudsters accountable and to build safe and strong communities here in the Eastern District of Washington.”

“Patients trust their doctors that the care they receive is necessary, particularly when they are undergoing neurosurgery,” said Washington Attorney General Bob Ferguson. “Performing unnecessary surgeries for profit is a betrayal of that trust. I’m proud of the work we did with U.S. Attorney Waldref and our federal partners, and we look forward to continuing our work together to protect Medicaid dollars for those who need them.”

“Our agency will continue to hold accountable medical providers who perform medically unnecessary procedures and fraudulently bill federal health care programs,” said Special Agent in Charge Steven J. Ryan of the Department of Health and Human Services Office of Inspector General (HHS-OIG). “Working closely with our law enforcement partners, HHS-OIG remains committed to protecting the health of patients and the integrity of the taxpayer-supported programs serving them.”

“Patients must be able to trust that when providers recommend surgery it is because it is necessary, not because it is profitable,” said Amy K. Parker, Special Agent in Charge of the Office of Personnel Management’s Office of Inspector General. “I am grateful for the outstanding work of our agents and law enforcement partners who helped protect patients from harm.”

“This multi-million dollar settlement holds Providence and its former doctors accountable for dubious actions that endangered patient safety and defrauded various healthcare programs, including the Department of Defense’s TRICARE program,” said Bryan D. Denny, Special Agent in Charge of the Department of Defense Office of Inspector General, Defense Criminal Investigative Service (DCIS), Western Field Office. “DCIS remains committed to working with its law enforcement partners in protecting the integrity of federal healthcare programs, which facilitates an environment for our healthcare providers to be truly focused on quality patient care and safety.”

According to court documents, the case began in January 2020, when a whistleblower, the former Medical Director of neurosurgery at Providence-St Mary’s, filed a qui tam complaint under seal in the U.S. District Court for the Eastern District of Washington. When a whistleblower, or “relator,” files a qui tam complaint, the False Claims Act requires the United States to investigate the allegations and elect whether to intervene and take over the action or to decline to intervene and allow the relator to go forward with the litigation on behalf of the United States. The relator is generally able to then share in any recovery. In this case, according to court documents, the United States intervened in the action in January 2022, and subsequently reached this settlement. Pursuant to the settlement agreement, the relator will receive $4,197,734 of the total settlement amount.

The settlement was the result of a joint investigation conducted by the U.S. Attorney’s Office for the Eastern District of Washington; the State of Washington, Office of the Attorney General, Medicaid Fraud Control Division; the U.S. Department of Health and Human Services, Office of Inspector General, Seattle Field Office, the Defense Criminal Investigative Service, Seattle Field Office; and the Office of Personnel Management, Office of Inspector General, Western Regional Office. The United States Attorney’s Office would also like to express special thanks and appreciation for the logistical support provided by the Walla Walla Police Department. Assistant United States Attorneys Dan Fruchter and Tyler H.L. Tornabene of the Eastern District of Washington handled this matter on behalf of the United States.

U.S. Attorney Waldref will be addressing the case at a press conference at 10:00 a.m. on April 12, 2022 in front of the Thomas Foley Federal Courthouse building at 920 W. Riverside Avenue, Spokane, Washington. She will be joined by Larissa Payne, Director of the Medicaid Fraud Control Division for the Washington State Attorney General’s Office.

final_providence_settlement_agreement_fully_executed.pdf

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