Louisville Physician Agrees to Pay $250,000 to Settle False Claims Act Allegations

Louisville, KY – Dr. James Charasika, a Louisville physician, agreed to pay $250,000 to resolve allegations that he and his practice, Louisville Patient Centered Medical Home (LPCMH), submitted false claims to Medicare, Medicaid, and TRICARE related to improper billing of services provided by nurse practitioners, announced U.S. Attorney Kyle G. Bumgarner of the Western District of Kentucky.

Medicare, Medicaid, and TRICARE pay for medical services provided by nurse practitioners, but the amount of payment is different than if the service is provided by a physician. The United States alleged that Dr. Charasika and LPCMH violated the False Claims Act by billing government programs as if he provided medical services when, in fact, the services were provided by nurse practitioners. For Medicare, if particular conditions are satisfied, services provided by a nurse practitioner may be billed as if they were performed by a physician, but the United States alleged that Dr. Charasika and LPCMH did not satisfy those conditions.

The claims resolved by this settlement include claims that were brought under the qui tam or whistleblower provisions of the False Claims Act. Under the Act, a private party can file an action on behalf of the United States and receive a portion of any recovery. The qui tam case is captioned United States of America v. Louisville Patient Centered Medical Home, P.S.C., et al., Case No. 3:20-cv-3390-CRS (WDKY). Under the qui tam provisions, the relators received more than $35,000 from the settlement proceeds. 

“This office is committed to investigating allegations of healthcare fraud and protecting federal healthcare programs,” said U.S. Attorney Bumgarner. “I appreciate the whistleblowers coming forward in this case and encourage others who see fraud to do the same.”

“The alleged conduct affects the integrity of the government healthcare programs that our most vulnerable citizens rely on,” said Kentucky Attorney General Russell Coleman. “I’m grateful for the opportunity for our team to work with our federal partners to investigate allegations of healthcare fraud.”

The Kentucky Office of Attorney General’s Medicaid Fraud Control Unit helped investigate this matter and received more than $68,000 of the settlement amount due to the alleged false claims submitted to Medicaid. The United States Department for Health and Human Services Office of Counsel to the Inspector General and Office of Investigations also helped obtain this settlement.

The investigation and resolution of this matter illustrates the government’s emphasis on combating healthcare fraud. One of the most powerful tools in this effort 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 800-HHS-TIPS (800-447-8477).

Assistant United States Attorney Timothy Thompson handled this matter.

The claims resolved by settlement agreement are allegations only. There has been no determination of liability.

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