New Jersey Company Agrees to Pay $1.89 Million to Settle Allegations that it Overbilled United States
NEWARK, N.J. – A Texas doctor and his office manager, who was also his wife, have agreed to pay more than $422,789 to resolve False Claims Act allegations that they received illegal kickbacks in violation of the Anti-Kickback Statute, U.S. Attorney Philip R. Sellinger announced today.
Vijesh Patel and his wife, Laju Patel, both of Port Neches, Texas, have agreed to pay $422,789 to resolve allegations that they received kickbacks in return for referring patients for laboratory testing. Both have agreed to cooperate with the Department of Justice’s investigations of, and litigation against, other participants in the alleged schemes.
“Patients deserve to know that the decisions their health care providers are making are based solely on their medical needs, not on some profit-making scheme,” U.S Attorney Philip R. Sellinger for the District of New Jersey said. “Our office will continue to pursue anyone responsible for actions that have the potential to corrupt the medical decision-making process.”
“Kickbacks can undermine a physician’s medical judgment, result in unnecessary testing, and increase healthcare costs borne by taxpayers,” Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division, said. “We will continue to pursue physicians, laboratories, and others responsible for schemes that violate rules intended to safeguard the integrity of federal healthcare programs.”
The Anti-Kickback Statute prohibits offering, paying, soliciting, or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid, and other federally funded healthcare programs. The Anti-Kickback Statute is intended to ensure that medical providers’ judgments are not compromised by improper financial incentives and are instead based on the best interests of their patients.
The settlement announced today resolves allegations that the Patels received kickbacks in violation of the Anti-Kickback Statute in return for Vijesh Patel’s referrals to three laboratories:
"This settlement demonstrates the Eastern District of Texas’s firm and continued commitment to pursuing all persons responsible for engaging in kickback schemes that inevitably harm the taxpayers, increase costs to care, and decrease access to health care,” said United States Attorney Brit Featherston for the Eastern District of Texas. “We remain vigilant in our pursuit to put a stop to those who partake in kickback schemes of this kind and to hold them accountable for the collective harm they caused.”
“Patients should be able to trust that their doctor’s medical recommendation is in their best interest and not influenced by the doctor’s financial gain,” said United States Attorney Adair F. Boroughs for the District of South Carolina. “Our office has and will continue to hold accountable those that give and receive illegal kickbacks, both to maintain the public’s trust in the healthcare system and to ensure taxpayer money is properly spent.”
“Health care providers engaging in kickback schemes corrupt the provider-patient relationship and impose hidden costs on the health care system,” said Assistant Special Agent in Charge Susan A. Frisco with the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). “Alongside our law enforcement partners, our agency is committed to safeguarding the integrity of federal health care programs by holding individuals who unlawfully bill the programs accountable for their actions.”
“Today’s outcome demonstrates the steadfast determination of the Department of Defense (DoD) Office of Inspector General’s Defense Criminal Investigative Service (DCIS) and our investigative partners to root out fraud perpetrated against TRICARE,” Acting Special Agent in Charge Gregory P. Shilling, DCIS Southwest Field Office said. “DCIS remains focused on protecting and preserving valuable taxpayer dollars by holding those accountable who attempt to defraud the DoD.”
The settlement was the result of a coordinated effort between the Civil Division’s Commercial Litigation Branch, Fraud Section and the U.S. Attorneys’ Offices for the Eastern District of Texas, District of New Jersey, and District of South Carolina, with assistance from HHS-OIG and DCIS. To date, the United States has recovered over $32 million relating to conduct involving True Health or MSO kickbacks to physicians in Texas, including False Claims Act settlements with 34 physicians, two health care executives, one office manager, and one laboratory. In addition, the United States has filed a lawsuit under the False Claims Act against former True Health CEO Christopher Grottenthaler and others, which is captioned United States ex rel. STF, LLC v. True Health Diagnostics, LLC, et al., No. 4:16-cv-547 (E.D. Tex.). A defendant who violates the act is liable for three times the amount of the government’s losses plus applicable penalties.
The government is represented by Assistant U.S. Attorney Kruti Dharia of the U.S. Attorney’s Office, District of New Jersey, Opioid Abuse Prevention and Enforcement Unit, Senior Trial Counsel Christopher Terranova in the Civil Division’s Commercial Litigation Branch (Fraud Section), Assistant U.S. Attorneys James Gillingham, Adrian Garcia and Betty Young in the U.S. Attorney’s Office for the Eastern District of Texas, and Assistant U.S. Attorney Beth C. Warren in the U.S. Attorney’s Office for the District of South Carolina.
The government’s pursuit of this matter illustrates the government’s emphasis on combating healthcare fraud. One of the most powerful tools in the government’s efforts to combat health care fraud is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services, at 1-800-HHS-TIPS (800-447-8477).
The claims resolved by the settlement are allegations only, and there has been no determination of liability.