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FALSE CLAIMS ACT SETTLEMENT REACHED WITH LOCAL DOCTOR FOR IMPROPER BILLING PRACTICES

JUNE 21, 2010

BOSTON, Mass. - The United States has reached a settlement with ANIL KUMAR, M.D., of Lincoln, and two medical offices owned by him, ADVANCED PAIN MANAGEMENT, INC., and NORTHEAST AMBULATORY CENTER, both of Stoneham, in connection with allegations that KUMAR submitted false claims for payment to Medicare, Medicaid and other federal programs.

United States Attorney Carmen M. Ortiz and Susan J. Wadell, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General - Office of Investigations, announced that the settlement which was finalized today. The settlement resolves allegations that KUMAR engaged in a variety of practices that resulted in the submission of false claims to government health insurance programs, including upcoding patient visits and anesthesia procedures, billing separately for materials and medications that had already been paid for by other government payments to his facilities and billing for services not rendered. These activities resulted in improper payments of nearly $300,000 by government health insurance programs. Under the terms of the settlement, the United States will recover twice that amount, or a total of $586,761.12, which will be returned to the affected state and federal programs and the U.S. Treasury.

“This case is yet another example of our commitment to ensuring that federal health care dollars are spent on the actual care of patients, not on lining the pockets of those who would abuse the billing system for their own gain,” stated U.S. Attorney Ortiz.

The civil settlement resolves two lawsuits filed under the qui tam, or whistleblower, provisions of the False Claims Act, which allow private citizens with knowledge of fraud to bring civil actions on behalf of the United States and share in any recovery. The two cases, both filed in the District of Massachusetts are United States ex rel Riley v. Anil Kumar et al., CV-06-10833-NMG and United States ex rel Lewis v. Anil Kumar et al., CV-07-12148-GAO. As part of today’s resolution, the whistleblowers will receive payments totaling $129,087.44 from the federal share of the civil recovery.

The investigation leading to the settlement was conducted by the Department of Health and Human Services Office of Inspector General. It was handled by Assistant U.S. Attorneys Zachary A. Cunha and Susan M. Poswistilo.

 

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