Western Maryland Physician and Pain Management Practice Group Agree to Pay $980,000 to Settle Federal False Claims Act Allegations of Billing for Medically Unnecessary Urine Drug Tests
Baltimore, Maryland – Melvin Gonzaga, M.D., his son Rommel Gonzaga, and their practice group Gonzaga Interventional Pain Management (“GIPM”) have agreed to pay the United States $980,000 to resolve allegations that they violated the federal False Claims Act by submitting false claims to the United States for urine drug tests (“UDT”) that were medically unnecessary.
The civil settlement was announced by United States Attorney for the District of Maryland Erek L. Barron; Special Agent in Charge Maureen Dixon of the Department of Health and Human Services – Office of Inspector General (HHS-OIG); and Assistant Inspector General for Investigations Paul A. Palumbo, of the U.S. Railroad Retirement Board Office of Inspector General (RRB-OIG).
“We are committed to ensuring that patients depending on government-funded insurance are not misled by doctors seeking to line their own pockets by performing medically unnecessary tests or treatments,” said United States Attorney Erek L. Barron.
“Providers who perform medically unnecessary procedures damage the trust of physician patient relationships and exploit taxpayer-funded programs,” stated Special Agent in Charge Maureen Dixon of the Department of Health and Human Services Office of Inspector General (HHS-OIG). “Along with our law enforcement partners, HHS-OIG is committed to protecting the health of patients and the integrity of federal health care programs serving them.”
“We are committed to holding unscrupulous Railroad Medicare providers accountable and are proud to be part of this collaborative effort,” said Railroad Retirement Board Assistant Inspector General for Investigations Paul A. Palumbo (RRB-OIG). “We would like to thank our law enforcement partners and the U.S. Attorney’s Office for their dedication and excellent work in this case.”
Dr. Gonzaga is a board-certified anesthesiologist and pain management specialist who owns and operates a pain management clinic, GIPM, located in LaVale, Maryland. Rommel Gonzaga is the chief executive officer of GIPM. From January 1, 2016 through March 31, 2019, GIPM billed the Medicare Program, the Medicaid Program, and the Railroad Retirement Board (“RRB”) for a large number of UDTs. GIPM tested its patients using two types of UDTs: presumptive and definitive. A presumptive UDT is an initial test to detect the presence or absence of a substance or class of substances in the body. A definitive UDT is a more advanced test that can identify individual drugs, distinguish between structural isomers, and report the results of drugs present in concentrations of nanograms per milliliter.
This settlement resolves allegations that the UDTs that GIPM billed to the government were not ordered based on an individualized determination of medical necessity for each patient. Instead, GIPM used blanket orders that tested all patients for the same 22+ drug classes. GIPM patients were required to provide a UDT sample upon entry into the clinic and before being seen by a provider and discussing the results from any prior UDT the patient received. Often, UDTs showing unexpected positive or negative results were ignored, or not checked at all, while GIPM providers continued to prescribe the patients opioids and other controlled substances despite obvious warning signs that the patients were abusing drugs.
The claims resolved by this settlement are allegations. The settlement is not an admission of liability by Dr. Gonzaga, Rommel Gonzaga, or GIPM, nor a concession by the United States that its claims are not well founded.
The case arose from an initiative launched by the United States Attorney’s Office for the District of Maryland which involves the use of specialized resources and personnel to review Medicare billing data. The review of that data has enabled the United States Attorney’s Office to identify areas of concern where it appears that billing irregularities may have taken place. Partnering with the affected agencies, the United States Attorney’s Office has developed the ability to investigate these billing irregularities to determine whether the matter is appropriate for enforcement under the False Claims Act.
United States Attorney Erek L. Barron commended the HHS-OIG and the RRB-OIG for their work in this investigation. Mr. Barron thanked Assistant U.S. Attorney Tarra DeShields and former Assistant United States Attorney Vince Vaccarella, currently a Trial Attorney in the Justice Department’s Civil Frauds Section, who handled this case.
For more information on the Maryland U.S. Attorney’s Office, its priorities, and resources available to report fraud, please visit www.justice.gov/usao-md and https://www.justice.gov/usao-md/report-fraud.
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