Former State Representative Paul DeWeese, M.D., Sentenced To Three Years' Probation For Health Care Document Fraud
Criminal Sentencing For $172,991 Fraud Follows A Separate $273,496 Civil Settlement And The Surrender Of Dr. DeWeese’s DEA Registration And Medical License
GRAND RAPIDS, MICHIGAN — Paul Nathan DeWeese, M.D., 61, of Holt, Michigan, was sentenced by the Hon. Robert Jonker, Chief U.S. District Court Judge, to three years’ probation and a $5,000.00 fine after pleading guilty to directing others to make and use false documents in connection with claims submitted to Blue Cross Blue Shield of Michigan ("BCBSM"). Dr. DeWeese paid $172,991.56 in criminal restitution prior to the sentencing hearing.
Dr. DeWeese, a two-term state representative from 1998 through 2002, was the President and Chief Executive Officer of NBO Medical, a chain of medical clinics that was devoted to treating peripheral neuropathy with a combination of nerve block injections and electrical stimulation treatments. In April 2012, Dr. DeWeese participated in the development of a directive at NBO Medical to comply with a BCBSM policy that required physicians to supervise nerve block injections administered by nurse practitioners. When he entered his plea of guilty to criminal health care fraud charges, Dr. DeWeese admitted that instead of performing the necessary supervision, he instructed his administrative assistant and others to place his signature on electronic medical records at NBO Medical, falsely denoting that the injections had been supervised. BCBSM would not have paid the affected claims without physician supervision of the sensitive medical procedures. The investigation of this case revealed that a number of Dr. DeWeese’s signatures originated outside the State of Michigan from electronic devices that were not affiliated with NBO Medical.
The criminal sentencing followed a March 2016 civil settlement in which Dr. DeWeese and NBO Medical paid $273,496.67 to Medicare and Medicaid to resolve allegations that NBO Medical violated the federal False Claims Act and the Michigan Medicaid False Claims Act by failing to refund overpayments for (1) electrical stimulation treatments and diagnostic vestibular tests that were improperly billed to those federal health care programs; and (2) services rendered by non-physician practitioners that were improperly billed, to federal health care programs, under Dr. DeWeese’s name.
Under the terms of the civil settlement, Dr. DeWeese also paid a $15,000.00 fine and voluntarily surrendered his DEA registration to resolve allegations that after closing NBO Medical, he also violated the federal Controlled Substances Act in his treatment of patients for pain and substance use disorders by (1) prescribing patients a combination of at least one opioid, one benzodiazepine, and carisoprodol (a combination colloquially referred to as the "Holy Trinity" for its rapid euphoric effects) on several occasions; (2) failing to address indicia of drug-seeking behavior in his treatment of certain patients; (3) prescribing Ritalin and Adderall to patients, on several occasions, without appropriate diagnoses or justifications; and (4) documenting, on numerous occasions, physical examinations of patients that did not occur. Dr. DeWeese also permanently surrendered his medical license to the State of Michigan as part of a separate licensing action, filed by the Michigan Bureau of Licensing and Regulatory Affairs and the Michigan Attorney General’s Office, that stemmed from the federal investigation of Dr. DeWeese’s controlled substance prescriptions.
The civil case, United States, et al., ex rel. Risner, et al. v. Paul N. DeWeese, M.D., P.L.C., et al., No. 1:12-cv-1308 (W.D. Mich.), resulted from a lawsuit filed by two former employees of NBO Medical. The lawsuit, known as a qui tam action, was filed under the False Claims Act and the Michigan Medicaid False Claims Act, which allow private whistleblowers to bring lawsuits on behalf of the United States and the State of Michigan and receive a share of any recoveries. In this case, the United States and State of Michigan intervened in the whistleblowers’ suit. The whistleblowers received $54,699.33 of the civil settlement proceeds, as well as additional amounts for attorney’s fees and costs.
U.S. Attorney Patrick Miles emphasized that his office sought prison time for Dr. DeWeese, who qualified for a term of 24 to 30 months of incarceration under the advisory U.S. Sentencing Guidelines. "When health care professionals engage in this type of conduct, they face civil fines, criminal restitution, suspensions and revocations of their licenses, and the possibility of imprisonment. As this case demonstrates, my office will aggressively use all available criminal, civil, and administrative remedies when it receives credible allegations of fraud and the improper prescribing of controlled substances. Document frauds in the health care field are particularly damaging because insurers rely on the accuracy and presume the authenticity of documents to assess the legitimacy of health care claims. As for improper prescribing of controlled substances, our opioid epidemic warrants the serious attention we give those allegations."
"Health care fraud investigations are among the highest investigative priorities within the FBI’s White Collar Crime Program. As one of the primary investigative agencies in the fight against Health Care Fraud, the FBI has jurisdiction over both federal and private insurance program fraud matters," said David P. Gelios, Special Agent in Charge, Detroit Division of the Federal Bureau of Investigation. "The Detroit FBI leverages its resources in the private and federal arenas through investigative partnerships with an expansive range of federal, state, and local agencies. As part of our national strategy to tackle Health Care Fraud, the FBI works closely with the Department of Justice and U.S. Attorney’s Offices throughout the country to more effectively disrupt the ability of medical professionals to defraud insurance providers by aggressively seeking parallel criminal and civil remedies."
Patricia Armstrong, Acting U.S. Postal Inspector in Charge, praised the cooperation of the law enforcement agencies involved in this investigation, saying, "It is an excellent example of what can be accomplished when federal and state law enforcement agencies share their resources and focus on a common goal."
The criminal and civil cases against Dr. DeWeese and NBO Medical resulted from a coordinated effort by the U.S. Attorney’s Office for the Western District of Michigan, the Michigan Attorney General’s Office, the Federal Bureau of Investigation, the United States Postal Inspection Service, the U.S. Department of Health and Human Services, Office of Inspector General, the Michigan State Police, the Michigan Department of Health and Human Services, and Blue Cross Blue Shield of Michigan.