Family Physician Pays $285,000 To Settle False Claims Act Allegations Of Billing Services At Inflated Rate
Knoxville, Tenn. – Family physician Dr. Chang-Wen Chen and his practice Chang-Wen Chen, M.D., P.C. paid $285,000 to resolve allegations that they violated the False Claims Act by improperly charging government health care programs the physician’s rate for services that were provided by nurse practitioners. The allegations challenged billings submitted to Medicare, Medicaid (“TennCare”) and TRICARE from 2013 through 2019.
Medicare and TennCare reimburse at the higher physician rate for services provided by nurse practitioners or other non-physician providers when the services are rendered “incident-to” a physician’s services, but only if the physician provides direct supervision. TRICARE always pays the reduced rate for services rendered by non-physician providers regardless of whether a physician supervises. The government alleged that Dr. Chen’s practice unlawfully billed government payors at the physician rate even when services were rendered by unsupervised nurse practitioners.
Under the False Claims Act, any person who presents false claims for payment to the United States is liable for three times the damages the government incurs as a result of the false claims and penalties ranging from $5,000 to $22,363 per violation, depending on when the violations occurred.
“False billing practices contribute to the rising cost of health care in our country, and cheat taxpayers out of billions of dollars each year,” said U.S. Attorney J. Douglas Overbey. “This settlement demonstrates the continued commitment of the United States Attorney’s Office to protecting the integrity of our federal health care programs.”
“Medicare and other government health payment rules on non-physician providers are clear. While nurse practitioners may provide excellent care, billing their services at an inflated rate cheats taxpayers who are paying for these vital services,” said Derrick Jackson, Special Agent in Charge of the Office of Inspector General of the U.S. Department of Health and Human Services. “Working with our law enforcement partners, we will continue investigating threats to federally funded health care programs.”
“I applaud the Department of Justice and the U.S. Attorney for the Eastern District of Tennessee for their continued efforts to hold health care providers accountable to the American taxpayer," said Army Lt. Gen. Ronald Place, director of the Defense Health Agency. "The efforts of the Department of Justice to safeguard the health care benefit for our service members, veterans and their families is commendable. The Defense Health Agency continues to work closely with the Justice Department, and other state and federal agencies to investigate all those who participated in fraudulent practices.”
This investigation was a coordinated effort by the U.S. Attorney’s Office for the Eastern District of Tennessee; the Tennessee Attorney General’s Office; the U.S. Department of Health and Human Services, Office of Inspector General; and the Tennessee Bureau of Investigation, Medicaid Fraud Control Unit. The investigation was prompted by a lawsuit filed in 2015 by a former nurse practitioner at the practice, under the qui tam or “whistleblower” provisions of the False Claims Act, which permit private individuals to sue on behalf of the government for false claims and to share in any recovery. The relator’s share of the recovery in this case is $51,300.
The case is captioned United States and State of Tennessee ex rel. Forester v. Chang-Wen Chen, M.D. and Chang-Wen Chen, M.D., P.C., Case No. 3:18-cv-51 (E.D. Tenn.).
Assistant United States Attorneys L. Margaret Harker, Jeremy S. Dykes, and Jessica Sievert represented the United States.
The claims settled by this agreement are allegations only; there has been no determination of liability.