Qui Tam Lawsuit and Federal Investigation Result in $1.45 Million Settlement by Vaughan Regional Medical Center, a LifePoint Health Subsidiary, Integrity Emergency Care, Inc. and Selma, Alabama Physicians Phillip Alan Hicks and Sai S. Namburu

United States (U.S.) Attorney Richard W. Moore, of the Southern District of Alabama, announces that Vaughan Regional Medical Center, a community hospital located in Selma, Alabama, along with emergency room physicians Dr. Phillip Alan Hicks and Dr. Sai S. Namburu, also of Selma, have agreed to pay $1.45 million to resolve allegations that they violated the False Claims Act.  Dr. Hicks, former Vaughan Chief of Staff and Director of Emergency Services, owned and operated Integrity Emergency Care, Inc., also a named and settling Defendant.

The allegations resolved by this settlement arose from a whistleblower lawsuit filed under the False Claims Act by Dr. Samuel Clemmons.  He alleged residents who were not fully licensed were independently covering shifts in the Vaughan Emergency Department (Vaughan ER Department).  According to Dr. Clemmons, he communicated with Vaughan and LifePoint Health about the illegal use of these residents in the Vaughan Emergency Department, and no action was taken.  The whistleblower will receive $275,000.00 of the recovered funds.

“The significance of this case highlights the responsibilities of medical professionals and healthcare administrators to protect their patients from harm, and to prevent fraud against any federal health insurance program during the performance of their duties,” said U.S. Attorney Richard W. Moore for the Southern District of Alabama.  “The citizens of the Selma community are entitled to quality healthcare administered by fully licensed physicians, and actions taken to put patient care in jeopardy and to circumvent state and federal law will not be tolerated.”

Per the investigation by the U.S., from mid-2009 to March 31, 2012, residents were recruited from the UAB-Selma Family Medicine Residency Program to independently treat patients in Vaughan’s ER Department outside the course and scope of their residency program.  The residents were not fully licensed and credentialed physicians, yet per the investigation, were paid $50 per hour cash along with licensed emergency room physicians who were also paid an extra $50 per hour to co-sign the residents’ charts.  This illegal moonlighting was perpetuated by falsifying medical records and submitting false claims to Medicare as if the services were provided by licensed physicians. 

“Patients expect treatment by fully qualified medical professionals, and taxpayers should never be paying for healthcare provided fraudulently by an unlicensed physician–as alleged in this case,” said Derrick L. Jackson, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services.  “We will aggressively work with our law enforcement partners in pursuit of those who would defraud government health programs and the individuals they serve.”

The investigation and litigation were conducted by the Office of Inspector General, Department of Health and Human Services, and the U.S. Attorney’s Office.  The FCA claims settled are allegations only, and there has been no determination of liability.  A copy of this press release may be found on the website of the United States Attorney’s Office for the Southern District of Alabama at http://www.justice.gov/usao/als/. The case is captioned U.S. ex rel. Clemmons v. Vaughan Regional Medical Center, et al., Civil Action No. 2:14-cv-416-TFM-C (S.D. Ala.).