Judge Orders Middle Georgia Family Rehab to Pay $9.6 Million in Damages for Submitting Hundreds of Fraudulent TRICARE/Medicaid Claims
G.F. “Pete” Peterman, III, United States Attorney for the Middle District of Georgia, and Georgia Attorney General Sam Olens announced today a civil settlement with a series of anesthesia businesses, collectively known as Sweet Dreams Nurse Anesthesia (Sweet Dreams). Sweet Dreams agreed to pay to the United States $1,034,416 and the State of Georgia $12,078.79 to resolve allegations that it violated the False Claims Act and the Georgia False Medicaid Claims Act by paying unlawful kickbacks to health care providers with the intent to induce referrals of Medicare and Medicaid patients.
The settlement marks the end of a 22-month investigation into a number of alleged violations of the Federal Anti-Kickback Statute and Medicaid policies by Sweet Dreams. One alleged scheme resolved by the settlement concerns Sweet Dreams’ provision of free anesthesia drugs to ambulatory surgery centers (ASCs) in exchange for the ASCs granting Sweet Dreams an exclusive contract to provide anesthesia services at those ASCs. A second alleged scheme resolved by the settlement concerns the agreement of an affiliate of Sweet Dreams to fund the construction of an ASC in Marietta, Georgia, in exchange for contracts for Sweet Dreams’ selection as the exclusive anesthesia provider at that facility and a number of other podiatry-based ASCs affiliated with the Marietta ASC.
This investigation began with a lawsuit filed by Adam Nauss under the whistleblower provisions of the False Claims Act and the False Medicaid Claims Act, which allow private citizens to bring civil actions on behalf of the Government and share in any recovery obtained. The case is captioned United States and State of Georgia ex rel. Adam Nauss v. Sweet Dreams Nurse Anesthesia, et al., 5:14-CV-330. Mr. Nauss will receive a share of the settlement payment pursuant to the whistleblower provisions.
Sweet Dreams fully cooperated in the investigation, after which the parties agreed to resolve the allegations made by the United States and certain allegations raised by Relator Nauss on behalf of the State of Georgia. The claims covered by the settlement are allegations only, and there has been no determination of liability.
“The giving of a kickback by one provider to induce referrals from another negatively impacts patient choice and fair competition among providers. For that reason, Medicare and Medicaid prohibit taxpayer money being used to pay for services that arise out of arrangements that violate the Anti-Kickback Statute,” said U.S. Attorney G.F. “Pete” Peterman. “By diligently enforcing the Anti-Kickback Statute in this district, our office protects the integrity of many federal programs and ensures that when a health care provider in Middle Georgia refers a patient to another provider, the referral is based on what is best for the patient rather than the provider’s own self-interest.”
Attorney General Olens said, “Medical decisions, such as the selection of an anesthesia provider, should not be influenced by the payment or receipt of a kickback. My office is committed to protecting the Medicaid program from fraud and abuse and holding Medicaid providers accountable for failing to comply with Medicaid policies and related criminal laws.”
The case was investigated by Special Agent Shawn McAleer of the Department of Health & Human Services, Office of Inspector General and Investigators Enedelia Bostrup and Shaketia Morgan of the United States Attorney’s Office for the Middle District of Georgia.
The United States’ civil settlement was reached by Assistant United States Attorney Todd P. Swanson and Assistant United States Attorney W. Taylor McNeill. The State of Georgia’s civil settlement was reached by Assistant Attorney General Elizabeth White of the Medicaid Fraud Control Unit (MFCU) after an investigation by former employees of the MFCU.
Inquiries regarding the case should be directed to Pamela Lightsey, United States Attorney’s Office at 478-621-2603.