Last week’s healthcare-related enforcement actions included several cases relating to diagnostic services, though only one involved lab testing. In that case, the owner and practice manager of a Georgia-based pain management practice settled false claims allegations relating to unnecessary diagnostic and urine drug tests for a cool $5 million. Three other key cases involved either fraud or false claims related to imaging diagnostic tests.
Key Healthcare-Related Enforcement Actions Announced from March 15 – March 22, 2023
| Date Action Announced | Defendant(s) | Allegations/Charges/Convictions | Result |
| March 20 | · Mark A. Ellis, MD (owner) · Ellis Pain Center (EPC) · Patsy Allen (practice manager) | Allegedly billed Medicare for urine drug tests that were either not performed or not medically necessary as well as for diagnostic tests that weren’t necessary for treating the pain management practice’s patients, thus violating the False Claims Act. | Settled for $5 million.1 |
| March 20 | · Luminis Health Doctors Community Medical Center, Inc., (DCMC) · Diagnostic Imaging Associates, LLC (DIA) | Maryland-based acute care hospital and radiology imaging practice allegedly had an agreement where DIA billed Medicaid and Medicare for both its own professional services as well as for DCMC’s technical services provided by its outpatient cancer screening center. DIA then paid DCMC part of the reimbursement it received from either Medicaid or Medicare, despite DCMC not being enrolled in, or eligible for, reimbursement from either program. | Settled for $2,002,052.17.2 |
| March 21 | · Dr. Oliver Jenkins · Sherry-Ann Jenkins | Ohio-based ear, nose, and throat doctor employed at the Toledo Clinic and his wife started a new business called The Toledo Clinic Cognitive Center, which claimed to offer Toledo Clinic patients showing symptoms of cognitive disorders neurocognitive testing, diagnosis, treatment, and referrals. However, the doctor never treated or saw these patients, who were instead diagnosed and treated by his wife, who held a PhD, but was not licensed to practice medicine in Ohio. The services were then billed to both the patients and healthcare benefits programs using Dr. Oliver Jenkins’ billing number. | Both defendants were convicted of healthcare fraud, wire fraud, mail fraud, and conspiracy. A sentencing date is still to be announced.3 |
| March 21 | University of Iowa | Allegedly billed Medicare through its academic medical center for X-ray interpretations done by resident physicians “where an attending physician’s review of the residents’ interpretations did not satisfy government payment requirements” of 42 C.F.R. § 415.180. | Settled for $16,444 and agreed to undergo mandatory training for its physicians.4 |
References:
- https://www.justice.gov/usao-mdga/pr/athens-georgia-pain-medicine-owner-practice-manager-agree-5-million-settlement
- https://www.justice.gov/usao-md/pr/acute-care-hospital-and-radiology-imaging-practice-pay-more-2-million-resolve-false
- https://www.justice.gov/usao-ndoh/pr/jury-convicts-pair-fraud-and-health-care-fraud-toledo
- https://www.justice.gov/usao-ndia/pr/university-iowa-agrees-training-payment-16444-resolve-united-states-allegations