Judge Orders Middle Georgia Family Rehab to Pay $9.6 Million in Damages for Submitting Hundreds of Fraudulent TRICARE/Medicaid Claims
VALDOSTA – A Valdosta doctor was found guilty of health care fraud following a seven-day trial in federal court, announced Charles “Charlie” Peeler, the United States Attorney for the Middle District of Georgia. The verdict was announced late in the day yesterday, May 14, 2019, after the jury deliberated for approximately two hours. The trial for Dr. Douglas Moss, 58, of Valdosta, began Monday, May 6, 2019 before U.S. District Judge Hugh Lawson. Dr. Moss was found guilty on all seven counts that he was charged with: Conspiracy to Commit Health Care Fraud (Count 1) and Health Care Fraud (Counts 2-7). The defendant faces a maximum penalty of ten (10) years in prison, a $250,000 fine, or both, on each count. The sentencing date is scheduled for August 14, 2019, at 9:30 a.m. before Judge Lawson. There is no parole in the federal system.
Dr. Moss was a practicing physician at South Georgia Health Group, LLC, (SGHG) in Valdosta, Georgia, since July 16, 2002. Dr. Moss was also the Medical Director of four Heritage Health (which became Pruitt Health) facilities (Holly Hill Nursing Home, Valdosta Nursing Home, Lakehaven Nursing Home, and Crestwood Nursing Home) between January 2011 and May 2016, where he served as the attending physician for 80 percent of the residents at those facilities. Dr. Moss was also the Medical Director of Grant Medical Clinic in Valdosta, an after-hours clinic. Dr. Moss enlisted a co-conspirator, Shawn Tywon, who worked as a Physician’s Assistant (PA) in Dr. Moss’ practice. Mr. Tywon was indicted in this case, and entered a guilty plea to Conspiracy to Commit Health Care Fraud on April 11, 2019, before Judge Lawson. Sentencing for Mr. Tywon is scheduled for July 10, 2019. Mr. Tywon testified in the trial as a witness for the Government.
According to testimony and evidence presented at trial, Dr. Moss bilked the U.S. Government out of more than $2.5 million dollars by falsifying Medicare and Medicaid claims, either by billing for services he actually did not perform, or by utilizing his PA, Mr. Tywon, as an “extender” (a non-physician practitioner) to render services that were billed as if Dr. Moss had performed them himself, netting a larger reimbursement. The evidence showed that Dr. Moss routinely did not render the services he billed under his name, and even visited casinos during at least two periods of time when he submitted bills for services in Valdosta when he was actually in Las Vegas.
“Over a period of four years, Dr. Moss stole in excess of $2.5 million by fraudulently billing the U.S. Government for work he claimed to personally perform at the four nursing homes in Valdosta. The jury’s verdict makes it clear that the citizens of our district will not stand for defrauding the government,” said Charles “Charlie” Peeler, the US Attorney for the Middle District of Georgia. “I want to thank our law enforcement partners for their hard work.”
“Our Medicaid Fraud Control Division will remain vigilant in efforts to uncover fraud and abuse,” said Attorney General Chris Carr. “The case gave us an opportunity to work hand-in-hand with our federal partners at the U.S. Attorney’s Office for the Middle District of Georgia, and we are proud that our joint efforts led to this successful result.”
“The level of greed shown by Dr. Moss in this case is astounding, as he lined his pockets at the expense of our government funded healthcare programs,” said Chris Hacker, Special Agent in Charge of FBI Atlanta. “Just as one example, Dr. Moss claimed to have seen 175 patients on one particular day, falsely billing Medicaid and Medicare for services that were never provided. Actions like this went on for over three years affecting every tax paying citizen, in particular, those who rely on federally funded programs for their health care needs.”
“Dr. Moss was convinced that defrauding taxpayers was his path to riches,” said Derrick L. Jackson, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services. “Instead he will pay a heavy price for his actions as we will work with our law enforcement partners to protect vital government health programs.”
The case was investigated by the Federal Bureau of Investigation and the U.S. Department of Health and Human Services – OIG. Assistant U.S. Attorneys Sonja Profit and Lyndie Freeman from the U.S. Attorney’s Office for the Middle District of Georgia, and Assistant Attorney General Jim Mooney from the Georgia’s Office of the Attorney General prosecuted the case for the Government. Questions can be directed to Pamela Lightsey, Public Information Officer, United States Attorney’s Office, at (478) 621-2603 or Melissa Hodges, Public Affairs Director (Contractor), United States Attorney’s Office, at (478) 765-2362.