In a settlement agreement approved this week by U.S. District Chief Judge Rebecca R. Pallmeyer, a suburban Chicago doctor and his surgical center have agreed to pay over $750,000 to the United States to settle a civil lawsuit. The lawsuit accused the doctor, John A. Greager II, and Cancer Therapy Associates, S.C., of submitting fraudulent claims to Medicare and a federal employee health program. According to the lawsuit, Greager and his surgical center violated the False Claims Act by performing multiple mole removal procedures on patients on a single date, but falsely claiming that the procedures had been performed on multiple dates. The settlement resolves the qui tam lawsuit, which allows private citizens to bring lawsuits on behalf of the United States for false claims. In addition to the settlement, Greager also faced a separate criminal prosecution and received a 6-month prison sentence and a fine of $1 million.
Suburban Chicago Doctor Settles False Claims Act Suit for Over $750,000
In a recent case in suburban Chicago, a doctor and his surgical center have agreed to pay over $750,000 to settle a civil lawsuit alleging fraudulent claims. The lawsuit, filed under the False Claims Act, accused the defendants of submitting false claims to Medicare and a federal employee health program. The allegations involve the practice of “unbundling,” where multiple mole removal procedures were performed on the same day but billed as if they were performed on separate dates.
Allegations of Fraudulent Claims
The allegations against the doctor and his surgical center revolve around the practice of unbundling. Unbundling refers to the practice of billing for separate services that should be billed together as a single procedure. In this case, the defendants performed multiple mole removal procedures on patients on the same day but submitted or caused the submission of claims that made it appear as if the procedures had been performed on separate dates. This practice allowed them to receive higher payments from Medicare and the Federal Employees Health Benefits Program (FEHBP) than they were entitled to.
The impact of these fraudulent claims on Medicare and FEHBP is significant. By billing for multiple procedures on separate dates, the defendants caused Medicare and FEHBP to pay more than they would have paid if the procedures had been billed together. This ultimately leads to higher healthcare costs for these programs and taxpayers.
The government has presented evidence to support the allegations of fraudulent claims. The evidence includes medical records and billing documents that demonstrate the unbundling practices employed by the defendants. This evidence was crucial in building the case against the doctor and his surgical center.
To resolve the civil lawsuit, the doctor and his surgical center have agreed to a settlement of $757,879.90 with the United States. The settlement agreement was approved by U.S. District Chief Judge Rebecca R. Pallmeyer. The terms of the settlement includes the payment of the agreed-upon amount by the defendants to the United States.
Qui Tam Lawsuit
This civil lawsuit was brought under the qui tam, or whistleblower, provisions of the False Claims Act. The Act permits private citizens, known as whistleblowers, to bring lawsuits on behalf of the United States for false claims. Whistleblowers in these cases can share in any recovery obtained through the lawsuit.
In this case, it is not specified whether the whistleblower’s identity is disclosed. The United States intervened in the lawsuit prior to the settlement, indicating that they saw merit in the allegations made by the whistleblower. The role of the whistleblower in bringing attention to the fraudulent claims and assisting in the investigation and prosecution of the case is crucial.
The settlement was announced by Morris Pasqual, Acting United States Attorney for the Northern District of Illinois, along with other officials. The announcement serves to inform the public and demonstrate the commitment of the government in pursuing and holding accountable those who commit fraud against federal healthcare programs.
Relevant statements from officials were included in the settlement announcement. These statements highlight the significance of the settlement and emphasize the government’s commitment to protecting the integrity of federal healthcare programs and ensuring taxpayer funds are used appropriately.
In addition to the civil settlement, the doctor faced a separate criminal prosecution. In this criminal case, the doctor was sentenced to 6 months in prison and a fine of $1 million. This criminal prosecution underscores the severity of healthcare fraud and the commitment of the government to pursue both civil and criminal remedies in these cases.
This case is not the first of its kind related to the False Claims Act. The article mentions previous cases that are relevant to the topic of false claims, indicating a pattern of fraudulent activity in the healthcare industry. These related cases provide context and demonstrate the ongoing efforts of the government to combat healthcare fraud.
The article also mentions relevant press releases related to the False Claims Act. These press releases may contain additional information on other cases and enforcement actions taken by the government. They serve as additional resources for readers interested in learning more about false claims and their consequences.
For individuals seeking more information or wishing to report healthcare fraud, contact information for relevant government agencies is provided. This includes the U.S. Attorney’s Office, the Federal Bureau of Investigation (FBI), the U.S. Department of Health and Human Services, Office of the Inspector General, the U.S. Department of Labor’s Office of Inspector General, and the U.S. Office of Personnel Management Office of the Inspector General. These agencies play a critical role in investigating and prosecuting healthcare fraud cases, and individuals are encouraged to reach out to them with any concerns or information they may have.