Florida Pain Medicine Associates and its Owners Agree to Pay Over One Million Dollars to Resolve False Claims Act Allegations
Florida Pain Medicine Associates, Inc. and its owners, Drs. Bart Gatz, Alexis Renta, and Albert Rodriguez have agreed to pay $1.1 million to resolve allegations that they violated the False Claims Act by billing Medicare for medically unnecessary nerve conduction studies (NCS).
Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, and Shimon R. Richmond, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), Miami Region, made the announcement.
“When health care providers bill for medically unnecessary procedures, they compromise patient care and the integrity of the Medicare program, for their own financial interests” said U.S. Attorney Wifredo Ferrer. “The United States Attorney’s Office is dedicated to investigating and resolving claims of Medicare fraud that can jeopardize the health care system.”
“When health care businesses and their owners improperly boost their profits by billing Medicare for medically unnecessary procedures, its taxpayers and patients who are left with a hefty tab,” said HHS OIG Special Agent in Charge Shimon R. Richmond. “We are committed to uprooting such schemes and eliminating waste in Federal health care programs.”
The United States alleged that patient records indicated that a substantial percentage of the NCSs that were performed at Florida Pain Medicine Associates were medically unnecessary. The NCSs were often administered without an accompanying electromyography (EMG) test, thereby substantially decreasing the diagnostic value of the procedure. This was especially true where the NCS was the sole basis for performing an epidural steroid injection.
The settlement announced today resolves allegations originally brought by Rosa Gomez, who had worked in Florida Pain Medicine Associates billing department, under the qui tam, or whistleblower provisions of the False Claims Act, which permit private individuals to sue on behalf of the government of the United States for the submission of false claims and to receive a share of any recovery. The False Claims Act authorizes the United States to intervene in such lawsuits and take over primary responsibility for litigation. Gomez’s will receive $242,000.
Mr. Ferrer commended the investigative work of HHS-OIG. The investigation and settlement were handled by Assistant U.S. Attorney Franklin Monsour.
The case is captioned United States ex rel. Gomez v. Florida Pain Medicine Associates, Inc., et al., Case No. 13-80856 CIV (S.D. Fla.). The claims settled by the lawsuit are allegations only and there has been no determination of liability.