National Spine and Pain Centers and Physical Medicine Associates will pay the federal government $3.3 million to settle allegations that they illegally billed Medicare and other federal healthcare providers, according to the U.S. Attorney’s Office for the Eastern District of Virginia.
Both organizations operate pain management clinics in northern Virginia, Fredericksburg, Va., and Glen Allen, Va. They are accused of billing for medical services as if they were provided by physicians, when they were actually performed by physician assistants and nurse practitioners. The pain clinics also ordered medically unnecessary urine drug tests and submitted illegal claims for those services, according to federal prosecutors. A former physician assistant at Physical Medicine Associates filed the lawsuit under the whistleblower provisions of the False Claims Act. The whistleblower will be awarded up to 25 percent of the settlement.
The settlement resolves civil fraud allegations that defendants billed Medicare and other federal healthcare providers for medical services performed by physician assistants and nurse practitioners as if physicians had provided the services, submitted claims for urine drug tests in violation of the Stark Law and/or the Anti-Kickback Statute, and ordered medically unnecessary urine drug tests.
The settlement resolves a lawsuit filed in the U.S. District Court for the Eastern District of Virginia by a former PMA physician assistant under the qui tam, or whistleblower, provisions of the False Claims Act. Under the False Claims Act, private citizens, also known as relators, can bring a suit on behalf of the United States and share in any recovery. Under the False Claims Act, relators are awarded 15 to 25 percent of the proceeds of the settlement amount depending on the extent to which the relator substantially contributed to the recovery.
The resolutions obtained in this matter were the result of a coordinated effort between the U.S. Attorney’s Office for the Eastern District of Virginia, the Department of Health and Human Services Office of Inspector General, the U.S. Office of Personnel Management Office of the Inspector General, and the Defense Criminal Investigative Service Office of Inspector General.