SAVANNAH, GA: On Thursday, Attorney General Jeff Sessions and Department of Health and Human Services (“HHS”) Secretary Tom Price, M.D., announced the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force, involving 412 charged defendants across 41 federal districts, including 115 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $1.3 billion in false billings. Of those charged, over 120 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics.
The operation also highlighted the great work being done by the Department of Justice’s Civil Division. In the past fiscal year, the Department of Justice, including the Civil Division, has collectively won or negotiated over $2.5 billion in judgments and settlements related to matters alleging health care fraud. In addition, HHS has initiated suspension actions against 295 providers, including doctors, nurses and pharmacists.
The Department of Justice’s nationwide enforcement actions were led and coordinated by the Criminal Division, Fraud Section’s Health Care Fraud Unit in conjunction with its Medicare Fraud Strike Force partners, a partnership between the Criminal Division, U.S. Attorney’s Offices, the FBI and HHS-OIG. In addition, the operation includes the participation of the DEA, DCIS, and State Medicaid Fraud Control Units. Thirty state Medicaid Fraud Control Units also participated. The operation focused on unlawful distribution of prescription narcotics, like opioids, and holding medical professionals responsible accountable for their wrongdoing.
As part of this national enforcement action, the United States Attorney’s Office for the Southern District of Georgia announced the following enforcement actions:
The United States filed a Criminal Information against Sherry McCormick alleging one count of Health Care Fraud. In the information, the United States alleged that from 2013 to 2015, McCormick defrauded Medicare, Tricare, and the Federal Employee Health Benefit Program of approximately $500,000 by submitting and causing the submission of fraudulent claims for medications that were not medically necessary and not prescribed by a doctor.
The United States reached a civil settlement with Allcare Pharmacy, a pharmacy operating out of Lyons, Georgia, totaling $175,000. Based on the actions of its former employee, McCormick, the United States contended that Allcare Pharmacy submitted claims and received payment for prescriptions for compounded medications that were not medically necessary and not prescribed by a doctor.
The United States intervened for the purposes of civil settlement in a qui tam filed against Atlantic Foot & Ankle, P.C., a physician practice previously operating out of several locations in Georgia, as well as an owner of the practice, Melissa Robitaille, D.P.M. The United States contended that Atlantic Foot & Ankle and Dr. Robitaille submitted claims and received payment for services that did not qualify for payment by misrepresenting the services actually rendered.
The United States reached a civil settlement with Ramachandra Paidi, M.D., a physician practicing out of Vidalia, Georgia, totaling $303,950. The settlement resulted from an investigation by the Department of Health and Human Services, Office of the Inspector General (“HHS-OIG”), the State of Georgia, and the United States Attorney’s Office for the Southern District of Georgia. Based on its investigation, the United States contended that, on several occasions, Dr. Paidi submitted claims to Medicare and Medicaid for psychotherapy services for twenty-four (24) hours or more of services in any given day.
The United States reached a civil settlement with Andrea Chancey, a physician assistant residing in Augusta, Georgia, totaling $10,000. The settlement resulted from an investigation by the DEA and the United States Attorney’s Office for the Southern District of Georgia. Based on its investigation, the United States contended that, acting in concert with a physician, Andrea Chancey dispensed Schedule II controlled substances without legal authority using pre-signed prescriptions.
The United States reached a civil settlement with Medical Center Pharmacies, based out of Statesboro, Georgia, and its owners, totaling $85,000. The settlement resulted from an investigation by the DEA and the United States Attorney’s Office for the Southern District of Georgia. Based on its investigation, the United States contended that Medical Center Pharmacies and certain pharmacists violated the Controlled Substances Act by negligently failing to make, keep, or furnish certain records regarding highly addictive Schedule II controlled substances, including opioids, as required by federal law.
The United States reached a civil settlement with Medical Villa Apothecary, based out of Augusta, Georgia, and certain pharmacists, totaling $75,000. The settlement resulted from a joint investigation by HHS-OIG, DEA, and the United States Attorney’s Office for the Southern District of Georgia. Based on its investigation, the United States contended that Medical Villa Apothecary and certain pharmacists violated the False Claims Act by submitting claims to Medicare for drugs that it did not dispense to patients. The United States further contended that Medical Villa Apothecary violated the Controlled Substances Act by negligently failing to make, keep, or furnish certain records regarding highly addictive Schedule II controlled substances, including opioids, as required by federal law.
The United States recently announced a civil settlement Rhine Drug Company, based out of Rhine, Georgia, and its owner, totaling $2,175,000, which involved similar allegations.
Acting United States Attorney James Durham said, “The Office will continue to hold accountable those who take advantage of federal health care programs and those who fail to act responsibly when prescribing or safeguarding opioids. Any such fraudsters or hucksters should steer clear of our district, or else expect to face jail time and substantial financial penalties for their acts.”
“Through our Medicaid Fraud Control Unit, our office will continue coordinating with federal partners to safeguard the integrity of Georgia’s Medicaid program,” said Attorney General Chris Carr. “Improper billing inflates costs and causes unnecessary waste in our healthcare system, and we remain dedicated to seeking out and eliminating these issues on behalf of our citizens.”
“We expect doctors and other medical professionals who bill Medicare and Medicaid to provide quality services to those served by the programs, not rip off scarce government health care funds," said Special Agent in Charge Derrick L. Jackson, of the U.S. Department of Health and Human Services, Office of Inspector General. “Coordinating with our law enforcement partners, our agents work hard to ensure those who steal from federal health care programs are brought to justice.”
"The top priority of the Defense Criminal Investigative Service is to preserve the integrity of critical Department of Defense programs, such as primary health care for our Warfighters and their families,” said John F. Khin, Special Agent in Charge, DCIS - Southeast Field Office. "DCIS will vigorously pursue and thoroughly investigate any health care provider or contractor who submits false or fraudulent claims to the DoD, so that limited tax payer dollars can be better spent on the most urgent needs for our national defense.”
The cases announced today were investigated by HHS-OIG Special Agents Martin Rowe and David Graupner; DCIS Special Agents Randall Temples and Mark Lewis; DEA Diversion Investigators Josh Barnes, Saul Melendez, George Taylor, Dwayne Jeffcoat, and George Zuban; Investigator Kimberly Reinken-Creamer of the United States Attorney’s Office, Southern District of Georgia; and Law Clerk Alison Slagowitz of the United States Attorney’s Office, Southern District of Georgia; Investigative Auditor Denise Colson and Investigator Kevin White. The United States was represented by Assistant United States Attorneys Shannon Statkus, Tricia Rhodes, Scarlett Nokes, J. Thomas Clarkson, Jason Blanchard, Anica Jones, and Bradford Patrick. The State of Georgia was represented by James Mooney. For additional information, please call the United States Attorney’s Office at (912) 201- 2522.
A complaint, information or indictment is merely an allegation, and all defendants are presumed innocent unless and until proven guilty. The claims resolved by civil settlements are allegations only; there has been no determination of liability. Investigations remain ongoing as to others arising out of these announced actions.