Texarkana, Texas, physician Dr. Donald S. Douglas, 50, has agreed to pay $118,000 to settle federal allegations of Medicare billing fraud tied to his clinics in Texarkana and New Boston, Texas. The deal resolves claims that Douglas systematically billed Medicare at the full physician rate for services rendered by advanced practice nurses who were not under direct physician supervision—as required by law.
Under Texas law, advanced practice nurses (APNs) can perform medical services and bill Medicare, but only at a reduced rate unless a physician is present for direct supervision. The U.S. alleges Douglas routinely submitted claims under his own provider number, charging the higher physician rate, even when he was not on-site to oversee the care. Those inflated billings ran through three clinics under his control, exploiting a loophole that cost the Medicare program thousands.
The settlement, finalized without an admission of liability, stems from a joint investigation by the Department of Health and Human Services Office of the Inspector General (HHS-OIG), the FBI, and the U.S. Attorney’s Office for the Eastern District of Texas. While the government does not allege that care was substandard or that services weren’t performed, it insists the billing practices violated federal healthcare rules designed to prevent fraud and protect taxpayer funds.
“Pursuing healthcare fraud is a top priority for my office,” said U.S. Attorney Joseph D. Brown. “When providers such as Dr. Douglas enrich themselves at the expense of Medicare, we will hold them to account.” Federal prosecutors emphasized that even non-malicious violations can trigger steep financial penalties when they undermine the integrity of federally funded programs.
CJ Porter, Special Agent in Charge at HHS-OIG, reinforced the message: “Patients can be assured that the government will investigate outlays of taxpayer funds earmarked for medical care to ensure it is delivered by properly licensed and supervised practitioners and at the correct and allowable rate.” The agency relies heavily on whistleblowers and the public to flag suspicious billing patterns.
The Medicare program, funded through federal taxes and administered by the Centers for Medicare & Medicaid Services (CMS), provides critical health coverage to seniors and disabled Americans. Fraudulent billing drains resources from this vital safety net. Tips can be reported anonymously to the Medicare Fraud Hotline at 1-800-HHS-TIPS. The civil settlement was negotiated by Assistant U.S. Attorney James Gillingham.
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Key Facts
- State: Texas
- Agency: DOJ USAO
- Category: Fraud & Financial Crimes
- Source: Official Source ↗
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