In our last update, we promised you more False Claims Act settlements, so we are back to bring you just that! The first is a healthcare case, and the second and third are, you guessed it, are more PPP cases.
$150,000 for Renting Out a Healthcare Provider’s Billing Number
Our next settlement comes out of our home office in Atlanta. In this case, a local physician paid $150,000 to settle claims that he had billed, or caused to be billed, Georgia Medicaid for services he had not provided. In sum, it was alleged that this provider had been paid by a local counseling center to let it use his provider number to bill for certain psychiatric services.
This case was not brought by an insider, but rather by an individual who mined the Medicare data looking for outliers. In this instance, he found that this particular provider had billed an “impossible” number of claims, meaning that if he had actually performed the services, he would have had to have worked non-stop for an excessive number of hours every day of the year.
This was possible to calculate because the codes being billed were time-based rather than a flat fee for a service. For example, our relator determined that to bill even a single one of the codes at issue, which required a minimum of 16 minutes of treatment, the provider would have to work a minimum of 11.9 hours per day for 365 days. Adding other codes brought that to 15.5 hours per day for 365 days. This was also 33,000 more claims for payment than this provider had submitted the prior year, making his billing a serious outlier in the data.
It is sometimes possible to achieve this through what Medicare calls “incident to” billing. This is where, for example, a single doctor in the office bills for treatments performed by nurse practitioners and physician assistants. Medicare allows this as long as the doctor is present in the building and performed the initial visit, so that the midlevel providers are essentially just providing the follow-up care.
Georgia Medicaid, however, does not permit incident to billing, even if this physician had met the requirements. Congratulations to Georgia Assistant Attorney General Sara Vann with the Georgia Medicaid Fraud Control Unit for seeing this through to a settlement. And thank you to our False Claims Act colleague Jonathan Kroner for allowing us to work on this matter with him.
A New PPP Relator Wraps Up Two More Settlements Totaling Almost $6 Million
In the same week, another of our PPP outsider relators—Blockquote Inc.—added two seven-figure settlements to its ledger.
Taking us back to Seattle, the Western District of Washington, led by Assistant U.S. Attorney Nickolas Bohl, reached a $2.1 million settlement with Vix Technology, a company that had received not quite $1.1 million in PPP loan forgiveness.
The second settlement, coming out of the Eastern District of Kentucky and headed up by Assistant U.S. Attorney Meghan Stubblebine, was with Topy America. This company had received the maximum $2 million Second Draw PPP loan and settled Blockquote’s case for more than $3.8 million.
Both cases had the same underlying theory, what we refer to as “foreign affiliation.” In sum, the Second Draw of PPP was limited to companies with fewer than 300 employees. Since the early days of PPP, the SBA had clarified that (a) the companies had to include employees of its affiliates (companies with common control, usually ownership or management) and (b) this included foreign employees.
Vix and Topy were both subsidiaries of much larger foreign conglomerates that, we alleged, exceeded the 300-employee limit when including those foreign employees.
This brings our firm’s grand total of PPP recoveries to about $17 million.
Even Small Scale Fraudsters Deserve to be Investigated
These drastically different settlements evince our firm’s ability to handle large cases while also its willingness to take on smaller cases. While we cannot take every viable case that comes into our office, we do seriously consider each and every one that is presented to us.
If someone is blatantly billing for services they didn’t provide, it may not matter that they only billed a small amount. If someone is actively harming patients with their fraud—like a home health company that’s not actually providing the services the patients need—then damages are not our primary concern.
We enjoy what we do and believe we serve an important role in the well-being of this country and its population. If you have witnessed a fraud, of any size, it couldn’t hurt to give us a call for a free consultation.
AND WE AIN’T DONE YET!