Pain Management Physician Resolves False Claims Act Allegations
ATLANTA – The U.S. Attorney’s Office for the Northern District of Georgia announced that pain management physician Dr. Anthony Clavo has agreed to the entry of a consent judgment for $430,000 plus interest to resolve allegations that he violated the False Claims Act by billing Medicare, Medicaid, and TRICARE for medically unnecessary services. The federal government’s portion of the consent judgment is $322,407, and the State of Georgia’s portion is $107,593.
“When physicians bill the government for medical services that are not needed by the patient, they violate the trust placed in them by their patients and the government to provide only medically necessary care,” said U. S. Attorney John Horn. “Healthcare providers should be vigilant about prescribing only medically necessary services for their patients.”
“Those individuals in positions of trust within the healthcare industry have an inherent duty to be forthright in their claims submittals to those government programs that pay for their services. Through the False Claims Act settlement and the associated monetary judgements announced today, the defendant in this case, Dr. Anthony Clavo, understands this and the U.S. Government’s position on this a lot better. The FBI will continue to play a role in ensuring that the federal funds providing these healthcare programs are not abused,” said George Crouch, Acting Special Agent in Charge, FBI Atlanta Field Office.
“Delivering medically unnecessary treatment or failing to document the need for that care can be a serious threat to the health of the patient as well as the federal programs they depend upon,” said HHS OIG SAC Derrick L. Jackson. “Together with our law enforcement partners we will be vigilant in pursuing such offenses.”
“Fighting Medicaid fraud has been and will remain a top priority for our office,” said Attorney General Chris Carr. “People who misuse our medical systems divert funds from those in need of care and abuse Georgia taxpayer dollars. We will continue to work with our statewide and national partners to aggressively pursue these instances.”
“This settlement highlights the commitment of the Defense Criminal Investigative Service (DCIS) and its law enforcement partners to protect the integrity of TRICARE, the Department of Defense health care program that serves our Warfighters, their family members, and military retirees,” said Special Agent in Charge John F. Khin, Southeast Field Office. “With DoD's limited resources and budgets, DCIS must continue to aggressively investigate fraud, waste, and abuse to preserve and recover precious taxpayer dollars for our most vulnerable programs.”
The government alleges that Dr. Clavo submitted or caused the submission of false claims to Medicare, Medicaid, and TRICARE for services that were not medically necessary or where there was insufficient information to determine the amount due the provider during the period from January 1, 2014 through June 22, 2015.
The settlement resolves allegations filed by Herretta Pickens and Teresa Williams, former employees of Dr. Clavo, under the qui tam, or whistleblower, provisions of the False Claims Act, which authorize private parties to sue for false claims on behalf of the United States and share in the recovery. The lawsuit was filed in the Northern District of Georgia and is captioned United States & State of Georgia ex rel. Herretta Pickens & Teresa Williams v. Southern Pain Institute, P.C. d/b/a Southern Spine & Pain Institute et al., No. 1:15-cv-2381 (N.D. Ga.). Ms. Pickens and Ms. Williams will receive a share of the 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 the Attorney General and the Secretary of Health and Human Services. 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 Justice Department has recovered a total of more than $31.6 billion through False Claims Act cases, with more than $19.2 billion of that amount recovered in cases involving fraud against federal health care programs.
The claims resolved by the settlement are allegations only, and there has been no determination of liability.
This case was investigated by the U.S. Attorney’s Office for the Northern District of Georgia, the U.S. Department of Health & Human Services Office of Inspector General, the Federal Bureau of Investigation, the Defense Criminal Investigative Service, and the Georgia State Attorney General’s Medicaid Fraud Control Unit.
The civil settlement was reached by Assistant United States Attorney Lena Amanti and Georgia Assistant Attorney General Sara Vann.
For further information please contact the U.S. Attorney’s Public Affairs Office at USAGAN.PressEmails@usdoj.gov or (404) 581-6016. The Internet address for the U.S. Attorney’s Office for the Northern District of Georgia is http://www.justice.gov/usao-ndga.