Psychiatrist Affiliated with Philadelphia and Lehigh Valley-Area Health Clinics Who Claimed to Have Seen Over 120 Patients per Day Agrees to Pay $91,109 to Resolve False Claims Act Liability

PHILADELPHIA – United States Attorney William M. McSwain announced that Pramod Pilania, M.D., has agreed to pay $91,109 to resolve potential liability under the False Claims Act. Dr. Pilania was a psychiatrist who previously saw patients at the Northeast Community Mental Health Centers (“Northeast clinic”) in Philadelphia and the Lehigh Valley Community Mental Health Centers (“Lehigh Valley clinic”), with locations in Allentown, Bethlehem, and Reading. According to the settlement, the United States contends that Dr. Pilania claims to have seen more than 120 Medicaid patients, including children, on a single day on several occasions in 2010. On each of the dates when he supposedly saw in excess of 120 patients, he also travelled between the Northeast clinic in Philadelphia and the Lehigh Valley clinic in Allentown, which are separated by approximately an hour’s drive. 

At the time of Dr. Pilania’s patient visits, Medicaid administrators required the “medication management” or “med check” visit to be 15 minutes in duration and also required the practitioner to record the time each visit began and ended on patient encounter forms. Seeing 120 patients for 15 minutes each would take 30 hours. According to the settlement agreement, Dr. Pilania did not see some of the 120-plus patients on those six dates for 15 minutes. Instead, many of the encounters were of extremely short duration. The settlement also alleges that Dr. Pilania did not record the beginning and ending times on patient encounter forms.   

This False Claims Act settlement with Dr. Pilania was preceded by a separate, related civil health care fraud lawsuit filed in 2015 against the Northeast and Lehigh Valley clinics where Dr. Pilania served as the Medical Director. That complaint also named the clinics’ principals, Melchor Martinez and Melissa Chlebowski, as defendants. At the time, the Northeast and Lehigh Valley clinics were the largest providers of mental health services to Medicaid patients in their respective regions. They generated $75 million in combined Medicaid and Medicare payments from 2009 through 2012. In 2018, the parties settled the lawsuit, and the United States obtained a $3 million consent judgment against the defendants.

“When physicians see Medicare or Medicaid patients, it is their responsibility to know the billing and payment rules required by those programs and abide by them,” said U.S. Attorney McSwain. “The allegations against Dr. Pilania – that he billed federally funded healthcare programs for over 120 patients per day while also commuting between locations that are an hour’s driving distance apart – are egregious. My Office is committed to rooting out healthcare fraud and protecting the integrity of our Medicare and Medicaid systems by holding everyone involved accountable, including any providers who try to cheat those systems.”

“Civil enforcement is an important tool in our ongoing battle against health care fraud,” said Maureen R. Dixon, Special Agent in Charge of the Office of the Inspector General for the U.S. Department of Health and Human Services. “We will continue to work closely with the United States Attorney’s Office to ensure the integrity of taxpayer funds and protect beneficiaries of federal healthcare programs.”

The government’s resolution of this matter illustrates the government’s 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 investigated by the U.S. Department of Health and Human Services’ Office of Inspector General and the U.S. Attorney’s Office for the Eastern District of Pennsylvania, with assistance from the Pennsylvania Office of Attorney General and the North Carolina Department of Justice. This matter was handled by Assistant U.S. Attorney Judith A. Amorosa and health care fraud auditor George Niedzwicki.

The claims resolved by this settlement are allegations only and there has been no determination of liability.