GREENSBORO – Med First Immediate Care & Family Practice, P.A. (Med First) has agreed to pay the government $1,450,000 to resolve False Claims Act allegations that its clinic in Dillon, South Carolina had been operating as a pill mill and falsely filing claims to Medicare and Medicaid for medically unnecessary urine drug testing (UDT), as well as lengthy and complex office visits that were not performed, announced U.S. Attorney Sandra J. Hairston.
The United States and the State of North Carolina alleged that between January 1, 2015, and August 15, 2019, Med First, through its Dillon clinic, knowingly submitted or caused to be submitted claims to Medicare and Medicaid for presumptive and definitive UDT that were not medically reasonable or necessary. Presumptive UDT are tests that screen for the presence of drugs, and definitive UDT are tests that identify the concentration of those drugs in a patient’s system.
The government contended that Med First performed both of these tests at nearly every patient office visit for patients on opioid therapy, and that the majority of patients at the Dillon clinic were receiving opioids during the relevant time period. Med First performed the repetitive testing without conducting individualized determinations of need or risk profile. In addition, the results of the UDT were often disregarded as the opioid prescription rarely altered despite unexpected UDT results.
The United States and the State of North Carolina further alleged that Med First billed for office visits, known as Evaluation and Management (E/M) services, at higher levels of complexity than actually provided to patients. There are five levels of E/M services, and the higher the level billed, the more complex and often lengthier the office visit must be. The government alleges that the Dillon clinic provider did not engage in complex office visits when spending little time with patients and simply refilling opioid prescriptions.
The United States initiated its investigation when a whistleblower filed a lawsuit under the qui tam provisions of the False Claims Act, which allow private parties to bring suit on behalf of the government and to share in any recovery. The whistleblower will receive $261,000 as his share of the governments’ recovery in this matter. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can also be reported to the Department of Health and Human Services at 800 HHS TIPS (800-447-8477).
“This office is committed to fighting against the opioid epidemic using all available resources, including the False Claims Act,” said Sandra J. Hairston, United States Attorney for the Middle District of North Carolina. “The government must deter all providers, and particularly those who prey on vulnerable populations, from enriching themselves off the federal health care programs with the submission of services that are not provided for legitimate medical need.”
“We are continuing to confront a deadly opioid crisis, brought on in part by irresponsible health care providers who flooded their community with unnecessary opioids pills,” said Attorney General Josh Stein. “My office will continue working with our state and federal partners to hold accountable providers who defraud North Carolina taxpayers and harm our people.”
“Providers who put their own profits above their professional responsibilities to appropriately serve their patients and to honestly bill federal health programs put both patient well-being and taxpayer funding at risk,” said Tamala E. Miles, Special Agent in Charge at the U.S. Department of Health and Human Services, Office of Inspector General. “Our agency, working closely with our law enforcement partners, will continue to investigate alleged health care fraud schemes to protect these safety net programs and the enrollees relying on them.”
This case was handled by the U.S. Attorney’s Office for the Middle District of North Carolina with assistance from the Office of Inspector General of the United States Department of Health and Human Services, as well as the North Carolina Attorney General’s Medicaid Investigations Unit. The United States was represented by Assistant United States Attorney Rebecca Mayer.
Source: United States Attorney’s Office
