KNOXVILLE, TN—A settlement was finalized
this week with Apex Medical Group, P.C., d.b.a. Nephrology Consultants, a local
nephrology physician practice group, and certain affiliated dialysis centers in
Knox and surrounding counties. Apex Medical Group (Apex) agreed to pay $4.36
million to settle alleged violations of the federal False Claims Act, the
Tennessee Medicaid False Claims Act, and other federal and state laws and
regulations.
A government investigation revealed that
from at least 2001 through 2006, Apex submitted numerous false and fraudulent
claims to government health programs, including Medicare and TennCare, for
payment through a pattern of upcoding for various physician services. During
that same time frame, the six dialysis clinics owned by Extracorporeal
Technologies, Inc., and Fort Sanders Kidney Center, Inc., improperly submitted
inaccurate claims to these government health programs for a variety of dialysis
services.
“The federal False Claims Act is
intended to provide a means for the government to recover moneys paid by
federal programs to persons and companies who have knowingly sought and
received funds to which they were not entitled.” explained U.S. Attorney Bill
Killian. The payment Apex must now make in connection with this settlement is
to compensate both federal and state government health programs, for funds it
received as a result of improper billing practices. “Public funds pay for the
largest share of healthcare services provided in the United States and we must
ensure that such funds are paid only when authorized by law,” said U.S.
Attorney Killian.
As part of this overall settlement, Apex
and Dr. Naseemul Siddiqi have entered into a comprehensive five-year Integrity
Agreement with the Office of Inspector General of the U.S. Department of Health
and Human Services to ensure the future compliance of the Apex with federal
health care benefit program requirements.
“This settlement is another example of
our strong commitment to aggressively pursue health care providers who
recklessly bill the Medicare program,” said Derrick L. Jackson, Special Agent
in Charge of the U.S. Department of Health and Human Services, Office of
Inspector General in Atlanta, Georgia. “The Office of Inspector General and the
U.S. Attorney’s Office will continue to protect taxpayer dollars.”
Tennessee Attorney General Bob Cooper said,
“The successful resolution of this case required a high degree of cooperation
between agencies. The coordinated pursuit of fraud is an essential component of
a well-run health care system.”
U.S. Attorney Killian further noted that
this settlement resolves a comprehensive investigation into allegations
regarding the Apex billing practices in an action filed on behalf of the United
States and the State of Tennessee under the qui tam (commonly known as the
whistle-blower) provisions of the federal False Claims Act.
The investigative team whose diligent
efforts resulted in this settlement was comprised of representatives from the
U.S. Department of Health and Human Services-Office of Inspector General
(HHS-OIG), Federal Bureau of Investigation (FBI), the U.S. Attorney’s Office
for the Eastern District of Tennessee, Tennessee Bureau of Investigation (TBI),
and the Tennessee Valley Authority Office of Inspector General (TVA-OIG).
U.S. Attorney Killian commended all who
participated in this complex investigation. He specifically noted the work of
lead HHS-OIG Special Agent Tony Maffei, FBI Forensic Accountant/Certified Fraud
Examiner LeAnn Lanz, TBI Special Agent Margaret Chiunard, and TVA-OIG Special
Agent Elizabeth Sherrod, along with Assistant U.S. Attorneys Betsy Tonkin, Rob
McConkey and Will Mackie, for their oversight of the parallel civil and
criminal investigation for the United States Attorney’s Office and Tennessee
Deputy Attorney General Peter Coughlan.
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