United States Settles False Claims Act Allegations Against Florida-Based Sleep Clinic And Physician For $250,000
Jacksonville, FL B The United States has settled a lawsuit against a central Florida-based sleep clinic for submitting false claims to the government. The qui tam or “whistleblower” complaint, filed by a former employee of the clinic, alleges that VMG Pulmonary and Sleep Institute and its physician/owner, Dr. Marivic Villa, violated the False Claims Act (FCA) by intentionally billing the government for hundreds of thousands of dollars of services that were not medically necessary, and that were performed by unlicensed, uncredentialed, and unsupervised employees.
The government announced today that it had reached a settlement with VMG and Dr. Villa. In reaching this settlement, the parties resolved allegations that, from January 1, 2009, until November 2012, Dr. Villa owned and operated sleep clinics in The Villages that were staffed by unlicensed and unsupervised employees. In many instances, these employees lacked the basic knowledge regarding the tests that they were performing. Despite Medicare payment rules that require that polysomnographic (PSG) tests be conducted by appropriately credentialed employees, the government contends that Dr. Villa only employed non‐credentialed employees. The government also contends that Dr. Villa continued to seek payment for claims to Medicare and TRICARE when she knew, or should have known, that she was violating the payment requirement by not having any appropriately credentialed employees administering PSG tests to beneficiaries. VMG and Dr. Villa agreed to pay $250,000 to resolve the claims.
"The United States Attorney's Office is committed to taking the steps necessary to protect Medicare, TRICARE, and other federal health care programs from fraud," said United States Attorney A. Lee Bentley, III. "By bringing FCA cases such as this, we hope to recover funds obtained through the fraud and deter others from attempting similar schemes."
This lawsuit was originally filed under the qui tam or whistleblower provisions of the False Claims Act by Donald Nichols, a former employee at the clinic. Under those provisions, a private party, known as a relator, can file an action on behalf of the United States and receive a portion of the recovery. Nichols will receive more than $50,000 as part of today’s settlement.
This settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by Attorney General Eric Holder and Secretary of Health and Human Services Kathleen Sebelius. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in this effort is the False Claims Act. Since January 2009, the Department of Justice has recovered a total of more than $19 billion through False Claims Act cases, with more than $13.4 billion of that amount recovered in cases involving fraud against federal health care programs.
This case was investigated by the U.S. Department of Health and Human Services - Office of Inspector General (HHS/OIG), the Defense Health Agency (DHA), HHS Office of Counsel to Inspector General (HHS/OCIG), and handled by Assistant United States Attorney Jason Mehta.
The claims resolved by this settlement are allegations only, and there has been no determination of liability. The lawsuit against the defendants was filed in the U.S. District Court for the Middle District of Florida and is captioned United States ex rel. Nichols v. VMG Pulmonary and Sleep Institute, Tri-County Pulmonary & Multi-Specialty Group, and Dr. Marivic Villa.