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Justice News

Department of Justice
U.S. Attorney’s Office
Western District of Tennessee

Tuesday, January 12, 2016

Local Dermatologist, Cordova-based Medical Practice to Pay $450,000 for Overbilling Medicare

Memphis, TN – A doctor and his Cordova-based medical practice will pay $450,000 to the government to resolve allegations that it billed Medicare for unnecessary dermatological surgical procedures and office visits. Edward L. Stanton III, U.S. Attorney for the Western District of Tennessee, announced the settlement today.

Under federal law, Medicare reimburses medical providers only for procedures that are medically necessary. The United States contends that from 2008 to 2011, Dr. George R. Woodbury and his medical practice, Rheumatology & Dermatology Associates, P.C., billed Medicare for multiple medically unnecessary procedures. Specifically, the complaint alleged that Woodbury billed for tissue rearrangement surgeries; excisions which were larger than actually performed; benign excisions as malignant; overstated repair or closure sizes; and for unnecessary office visits.

In October 2014, the allegations resolved in this settlement were first raised in a lawsuit filed against the defendant under provisions of the False Claims Act. The law provides the United States with a cause of action against any person who knowingly presents or causes to be presented a false or fraudulent claim for payment or approval. Damages for liability under the False Claims Act are up to triple the amount of actual damages suffered by the United States, plus a mandatory civil penalty of $5,500 to $11,000 for each claim.

"Billing Medicare for dermatological surgical procedures that are not necessary or appropriate contributes to the soaring costs of health care and harms patients," said U.S. Attorney Stanton. "Settlements like this protect public funds and safeguard the beneficiaries of federal health care programs."

The investigation was conducted by the United States Department of Health and Human Services – Office of the Inspector General, along with the Federal Bureau of Investigation.

Assistant U.S. Attorneys Stuart J. Canale and David Brackstone represented the United States in this matter.

The claims settled by this agreement are allegations only, and there has been no determination of liability.

Updated January 12, 2016