CHARLOTTE, N.C. - U.S. Attorney Jill Westmoreland Rose announced today that Piedmont Pathology in Hickory, N.C., has agreed to pay the United States $601,000 to settle allegations that it violated the False Claims Act by submitting false claims to Medicare and Medicaid for medically unnecessary procedures.
U.S. Attorney Rose is joined in making today’s announcement by Derrick L. Jackson, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General for the region including North Carolina.
“Government healthcare programs serve a vital role in providing necessary services to the citizens of our district,” said U.S. Attorney Rose. “This office is dedicated to ensuring that money is spent wisely on medically necessary services that benefit healthcare consumers as opposed to profiting the bottom line of healthcare providers.”
“Patients should be able to trust that their health care providers only provide medically necessary services,” said Special Agent in Charge Jackson. “Working in close coordination with the U.S. Attorney’s Office, we will continue to pursue health care companies that threaten the integrity of federal health care programs.”
The allegations arose from a lawsuit filed by a whistleblower, Dr. Kim Geisinger (the Relator), under the qui tam provisions of the False Claims Act. Relator Dr. Geisinger is a pathologist who formerly worked for Piedmont Pathology. Under the False Claims Act, private citizens can bring suit on behalf of the government for false claims and share in any recovery. The case is investigated by the United States, which can choose to take over the case or allow the Relator to pursue the case. Relator Dr. Geisinger will receive approximately $120,200 from the recovery announced today.
According to court documents, pathology practices apply stains to specimens to allow pathologists to identify abnormalities in the tissue. These stains include a routine hemotoxylin and eosin (H&E) stain and other special stains for various purposes. Among other things, the complaint alleges that a pathologist should review the specimen with the routine H&E stain before any special stain is used on the specimen. Special stains are billed separately to government healthcare programs. The government considers the use of special stains before the analysis of the routine H&E stained specimen to be medically unnecessary. In November 2016, the United States intervened in the case, pursuing claims that Piedmont Pathology lacked medical necessity for the special stains conducted on certain gastric biopsies before a pathologist reviewed the routine H&E stained specimen.
In making today’s announcement U.S. Attorney Rose thanked HHS-OIG for their coordination with the U.S. Attorney’s Office in investigating this case. The settlement was negotiated by Assistant U.S. Attorney Jonathan Ferry, of the U.S. Attorney’s Office in Charlotte.
The case is captioned United States of America ex rel. Geisinger v. Piedmont Pathology Associates, Inc. and Piedmont Pathology, Professional Corporation, Case No. 5:14-CV-121. The claims settled by the lawsuit are allegations only and there has been no determination of liability.