On April 19, 2019, the United States Government reached a settlement of approximately $3.3 million with Physical Medicine Associates, Ltd. (PMA) and PMA’s practice management company National Spine and Pain Centers, LLC (National Spine) to resolve False Claims Act allegations filed by a whistleblower, who was represented by Cohen Milstein.
In settling, the defendants did not admit liability. Other defendants named in the whistleblower’s complaint were dismissed as part of the settlement agreement.
The lawsuit was filed under seal in 2015 by Cohen Milstein on behalf of whistleblower Michelle O’Connor, a physician assistant and former PMA employee, in the U.S. District Court for the Eastern District of Virginia. It alleged that PMA, which operates several pain management practices in Virginia, doing business as National Spine & Pain Centers, overcharged Medicare, TRICARE, and the Federal Employees Health Benefits (FEHB) Program for medical services and ordered quantitative urine drug tests that were medically unnecessary, and which were billed to the federal health care programs.
Specifically, the whistleblower identified three kinds of unlawful conduct that allegedly occurred at various times going back to 2010: (1) billing for services performed by physician assistants and nurse practitioners as “incident to” a physician’s service when the services actually performed did not qualify as such, resulting in the government overpaying for the services; (2) submitting claims for urine drug tests that were in violation of the Stark Law and/or the Anti-Kickback Statute and therefore ineligible for reimbursement by the government; and (3) referring patients for medically unnecessary “quantitative” urine drug tests performed and billed to the government by third-party laboratories.
The federal False Claims Act and its state law equivalents permit private citizens to bring lawsuits on behalf of the government against persons who present false or fraudulent claims for payment under government contracts or programs, such as Medicare, TRICARE, and the FEHB Program. Whistleblowers, like Ms. O’Connor in this case, are entitled to receive a portion of the proceeds of any settlement or judgment awarded against a defendant.
The case is captioned United States of America ex rel. Michelle O’Connor v. National Spine and Pain Centers, LLC, et al., No. 3:15-cv-00551 (E.D. Va.).