United States Attorney Anne M. Tompkins
Western District of North Carolina
MONROE PHYSICIAN TO PAY $950,000 TO SETTLE GOVERNMENT CIVIL FRAUD ALLEGATIONS Millicent Francis-Lane, M.D. has agreed to pay $950,000 to the North Carolina Medicaid Program to resolve False Claims Act allegations, announced Anne M. Tompkins, U.S. Attorney for the Western District of North Carolina and North Carolina Attorney General Roy Cooper. Dr. Francis-Lane owns Union County Women’s Care, which has offices in Monroe, N.C.
The settlement was reached following a multi-year investigation by state agents and investigators into the Union County gynecologist’s billing practices. Investigators found that Dr. Francis-Lane knowingly billed Medicaid for more extensive services than she actually provided, a practice known as “upcoding.” By upcoding, Dr. Francis-Lane was reimbursed for significantly more than she would otherwise have received for her services. Government investigators found that Dr. Francis-Lane also regularly billed Medicaid for unnecessary tests. The billings at issue were submitted over a seven-year period from 2003-2009 inclusive.
As a condition of the civil settlement, Dr. Francis-Lane is required to reimburse the government for the amount she wrongfully received from Medicaid and also pay substantial penalties back to the program. The $950,000 settlement figure represents more than twice the wrongful billings Dr. Francis-Lane submitted to the Medicaid program. In addition, Dr. Francis-Lane was required to enter into an Integrity Agreement with the U.S. Department of Health and Human Services. Under this agreement, Dr. Francis-Lane is required to hire, at her own expense, a government-approved auditor who will monitor her billing practices for a five-year period, to ensure that neither she nor her clinic commit similar offenses against government health programs in the future.
“Dr. Francis-Lane’s false billing practices led to the exploitation of Medicaid, a tax-payer funded program that so many people depend on to cover their health care needs,” said U.S. Attorney Tompkins. “Our office will continue to vigorously enforce the False Claims Act to protect important public health care programs from fraud and abuse and to recover tax payer dollars that help support them.”
“Overcharging Medicaid wastes tax dollars that could be better spent providing real care for needy patients,” said North Carolina Attorney General Roy Cooper. “Cooperation between our office and federal officials is key to bringing Medicaid cheaters to justice.” The settlement resolved government allegations that Dr. Francis-Lane’s behavior violated the United States and North Carolina False Claims Acts. Under the False Claims Acts, 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 funds recovered will be returned to the North Carolina Medicaid Program that was the victim of Dr. Francis-Lane’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.
Investigators and attorneys with the North Carolina Medicaid Investigations Unit handled the case for the North Carolina Attorney General’s Office. Assistant United States Attorney Donald H. Caldwell, Jr. handled the case for the U.S. Attorney’s Office in Charlotte.
The investigation was the work of the Western District’s joint Health Care Fraud Task Force. The Task Force is multi-agency team of federal and state investigators and prosecutors who are dedicated to identifying and punishing those who defraud the health care system, and to reduce the potential for health care fraud in the future. The Task Force focuses on the coordination of cases, information sharing, identification of trends in health care fraud throughout the region, staffing of all whistle blower complaints, and the creation of investigative teams so that individual agencies may focus their unique areas of expertise on investigations. The Task Force builds upon existing partnerships between the agencies and its work reflects a heightened effort to reduce fraud and recover taxpayer dollars.