United States Files False Claims Act Suit Against General Medicine, P.C. and Related Entities for Medicare Fraud

East St. Louis, Ill. – The United States filed suit in U.S. District Court for the Southern 
District of Illinois against General Medicine, P.C. (“General Medicine”), Thomas M. Prose, M.D. – 
the owner of General Medicine, and seventeen related corporate entities owned by Prose. In a 
96-page complaint, the government alleges Defendants violated the False Claims Act in a widespread 
healthcare fraud scheme involving the submission of thousands of false claims to the Medicare 
program. Since 2016, Medicare has paid defendants over $40 million dollars.

General Medicine and the other defendant companies owned by Prose are based in Novi, Michigan and 
employed physicians and nurse practitioners to treat patients in nursing homes and assisted living 
facilities  in  numerous  states,  including  Illinois  and  Missouri.  The  government’s  
complaint  alleges Defendants  knowingly  billed  Medicare  for  visits  with  facility  residents  
that  were  not  medically necessary, did not meet the requirements of the billing codes, or were 
not performed at all. As alleged in  the  complaint, these  visits  resulted  from  General  
Medicine  directing  their  physicians  and  nurse practitioners to meet visit quotas and perform 
numerous patient visits and assessments each month without any consideration as to whether the 
patients needed the services. Defendants also allegedly submitted inflated claims to Medicare using 
billing codes for complex, comprehensive visits when the providers  spent  only  minimal  time  
with  patients.  On  multiple  occasions,  Defendants  allegedly completed progress notes 
containing inaccurate information or embellished portions of the notes to bill the visits using 
codes with higher reimbursement rates.

“Vulnerable patients living in nursing homes and assisted living facilities should receive their 
medical care based on their medical needs, not needless visits manufactured to meet artificial 
corporate quotas,” said U.S. Attorney Steven D. Weinhoeft. “Billing Medicare for unnecessary and 
worthless services at inflated rates drains valuable taxpayer funding from the program and 
ultimately harms the patients who need  it most. We  will continue to work closely with our  law  
enforcement partners to  ensure federally funded healthcare programs are not abused.”

The investigation was a collaborative effort by the U.S. Attorney’s Office for the Southern 
District of Illinois, the U.S. Department of Health and Human Services – Office of Inspector 
General (HHS OIG), the Illinois State Police Medicaid Fraud Control Unit, the Federal Bureau of 
Investigation, the U.S. Department  of  Labor  –  Office  of  Inspector  General,  the  U.S.  
Department  of  Labor  –  Employee Benefits Security Administration, the United States Postal 
Inspection Service, and the Department of Defense  Office  of  Inspector  General.  The  
investigation  has  already  resulted  in  former  General Medicine    nurse    practitioner    
Jami    Mayhew    pleading    guilty    to    healthcare    fraud    (see https://www.justice.gov/usao-sdil/pr/madison-county-nurse-pactitioner-pleads-guilty-healthcare-fraud) and the indictment of Phillip Greene, a former General Medicine physician, in September 2021.

The United States is represented in the civil litigation by Assistant U.S. Attorneys Nathan Wyatt and Laura Barke.
The case is captioned United States v. General Medicine, P.C., et al., No. 22-cv-00651-SMY (S.D. 
Ill.). The claims asserted in the complaint are allegations only, and there has been no 
determination of liability.

Members of the public who believe they may have information related to this or any similar schemes 
involving healthcare fraud in nursing homes are encouraged to contact law enforcement by calling 
the HHS OIG fraud hotline at 1-800-HHS-TIPS (1-800-447-8477) or by going online at
https://oig.hhs.gov/fraud/report-fraud/.