DEPARTMENT OF JUSTICE

United States Attorney Anne M. Tompkins
Western District of North Carolina

FOR IMMEDIATE RELEASE
THURSDAY, APRIL 21, 2011

CONTACT: Lia Bantavani
704.338.3140
FAX NUMBER: 704.227.0264

MONROE PHYSICIAN TO PAY $750,000 TO SETTLE GOVERNMENT CIVIL FRAUD ALLEGATIONS CHARLOTTE, N.C. - Latika Dushyant Patel, M.D., of Monroe, has entered into a settlement agreement with the United States, under which she will repay $750,000 to the North Carolina Medicaid Program in order to resolve government allegations that she billed the program for services she did not provide. Today’s announcement is made by Anne M. Tompkins, U.S. Attorney for the Western District of North Carolina and North Carolina Attorney General Roy Cooper.

The settlement was reached following a multi-year investigation by state investigators into the Union County gynecologist’s billing practices. Dr. Patel owns Carolina Obstetrics and Gynecology, P.C., in Monroe, N.C. The government’s investigation arose from a referral by the Program Integrity Section of the North Carolina Division of Medical Assistance. Investigators found that Dr. Patel knowingly billed the Medicaid program for more extensive services than she actually provided, a practice known as “upcoding.” By upcoding, Dr. Patel was reimbursed for significantly more than she would otherwise have received for her work. Government investigators also found that Dr. Patel regularly billed Medicaid for services provided at a local hospital when she was not present and did not attend patients. Further, Dr. Patel sometimes billed for unnecessary procedures. The billings at issue were submitted over a six-year period from 2003-2008 inclusive.

As a condition of the civil settlement, Dr. Patel is required to reimburse the government for the amount she wrongfully received from the Medicaid program, and also pay substantial penalties back to the program. The $750,000 settlement figure represents more than twice the amount of wrongful billings Dr. Patel submitted to the Medicaid program. In addition, Dr. Patel is required to enter into an Integrity Agreement with the U.S. Department of Health and Human Services. Under this agreement, Dr. Patel must hire a government approved auditor to ensure that neither she nor her clinic commit similar offenses against government health programs in the future. Her billing practices will be monitored for a five-year period.

The funds recovered will be returned to the North Carolina Medicaid Program, the victim of Dr. Patel’s wrongful billing practices. The Medicaid program provides payment for the health care costs of low-income parents, children, seniors, and people with disabilities in North Carolina. The settlement resolved government allegations that Dr. Patel’s billing practices violated the federal False Claims Act. Under the False Claims Act, physicians and other health care providers who submit false claims for reimbursement to the government are liable for up to three times the damages caused in addition to penalties of up to $11,000 per violation.

The investigation was conducted jointly by the North Carolina Attorney General’s Medicaid Investigations Unit and the U.S. Attorney’s Office for the Western District of North Carolina. Investigators and attorneys with the North Carolina Attorney General’s Medicaid Investigations Unit worked with Assistant United States Attorney Donald H. Caldwell, Jr., who handled the case for the U.S. Attorney’s Office in Charlotte.