General Medicine, Medicare Fraud, Illinois 2022
General Medicine, Medicare Fraud, Illinois 2022
In a shocking case of healthcare fraud, the United States has filed a lawsuit against General Medicine, P.C. and its owner, Thomas M. Prose, M.D., for allegedly submitting thousands of false claims to the Medicare program.
According to the 96-page complaint filed in U.S. District Court for the Southern District of Illinois, General Medicine and its affiliated entities, which are based in Novi, Michigan, employed physicians and nurse practitioners to treat patients in nursing homes and assisted living facilities in numerous states, including Illinois and Missouri.
The government alleges that Defendants knowingly billed Medicare for visits with facility residents that were not medically necessary, did not meet the requirements of the billing codes, or were not performed at all. As alleged in the complaint, these visits resulted from General Medicine directing their physicians and nurse practitioners to meet visit quotas and perform numerous patient visits and assessments each month without any consideration as to whether the patients needed the services.
The lawsuit also alleges that Defendants submitted inflated claims to Medicare using billing codes for complex, comprehensive visits when the providers spent only minimal time with patients. On multiple occasions, Defendants allegedly completed progress notes containing inaccurate information or embellished portions of the notes to bill the visits using codes with higher reimbursement rates.
“Vulnerable patients living in nursing homes and assisted living facilities should receive their medical care based on their medical needs, not needless visits manufactured to meet artificial corporate quotas,” said U.S. Attorney Steven D. Weinhoeft.
Since 2016, Medicare has paid defendants over $40 million dollars. The investigation was a collaborative effort by the U.S. Attorney’s Office for the Southern District of Illinois, the U.S. Department of Health and Human Services – Office of Inspector General (HHS OIG), the Illinois State Police Medicaid Fraud Control Unit, the Federal Bureau of Investigation, the U.S. Department of Labor – Office of Inspector General, the U.S. Department of Labor – Employee Benefits Security Administration, the United States Postal Inspection Service, and the Department of Defense Office of Inspector General.
The case is captioned United States v. General Medicine, P.C., et al., No. 22-cv-00651-SMY (S.D. Ill.). The claims asserted in the complaint are allegations only, and there has been no determination of liability.
The public is encouraged to contact law enforcement by calling the HHS OIG fraud hotline at 1-800-HHS-TIPS (1-800-447-8477) or by going online at https://oig.hhs.gov/fraud/report-fraud/ if they have information related to this or any similar schemes involving healthcare fraud in nursing homes.
Defendant: General Medicine, P.C. and Thomas M. Prose, M.D.
Criminal Charges: Violation of the False Claims Act
City and State: Novi, Michigan, and East St. Louis, Illinois
Date: 2022
Outcome: Lawsuit filed
Dollar Amounts: Over $40 million dollars in payments from Medicare
Key Facts
- State: Illinois
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
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