Doctors and Medical Facilities in Lehigh Valley Pay $690,441 to Resolve Healthcare Fraud Allegations
PHILADELPHIA – Dr. Yasin Khan, Dr. Elizabeth Khan, Dr. Dong Ko, Westfield Hospital and affiliated entities including a related pain clinic, Lehigh Valley Pain Management, have agreed to pay $690,441 to the federal government to resolve allegations that they violated the False Claims Act by submitting false health care billings to the Medicare, Federal Employees Health Benefits, and United States Department of Labor-Office of Workers’ Compensation programs.
The settlement resolves allegations in a complaint filed in federal court in the Eastern District of Pennsylvania by a whistleblower under the qui tam provisions of the False Claims Act. The qui tam provisions allow private citizens to bring civil actions on behalf of the United States and share in any recovery. The whistleblower, Margaret Reynard, will receive approximately $124,000 of the recovery.
In the qui tam complaint, the whistleblower alleged that the defendants submitted claims to the federal government to receive reimbursement for services performed by non-physicians as “incident to” the services of supervising physicians when, in fact, supervising physicians were away from the office or otherwise incapable of supervising. Billing services as “incident to” a physician’s supervision commands a higher reimbursement rate than billing those same services without physician supervision. Because physicians were not available to provide the supervision that the government programs required, the whistleblower alleged that defendants’ “incident to” billing was improper and resulted in false claims during the period from July 1, 2007 through December 31, 2013. There has been no determination of civil liability. The settled civil claims are allegations only.
As part of the settlement agreement, the defendants also agreed that, for the next thirty months, they will not submit claims to federal payors for any services performed by non-physician providers under the rate that applies for services rendered “incident to” the services of a physician, regardless of whether or not the claims could be billed properly in that manner.
This case was investigated by the U.S. Department of Health and Human Services Office of the Inspector General, the U.S. Office of Personnel Management Office of the Inspector General, the U.S. Postal Service Office of the Inspector General, and the U.S. Department of Labor Office of the Inspector General. It was handled by Assistant United States Attorneys Gregory B. David and Michael S. Macko.