Consumer Fraud

Whistleblower Helps U.S. Recover Nearly $700,000 From Pennsylvania Physicians, Affiliates

Pills Stethascope on Money 435x289 Whistleblower Helps U.S. Recover Nearly $700,000 From Pennsylvania Physicians, AffiliatesThree Allentown, Penn., doctors, a hospital, and a pain clinic have agreed to pay the U.S. government nearly $700,000 to settle a False Claims act lawsuit brought by a whistleblower who accused the defendants of defrauding federal health care programs and benefits.

Whistleblower Margaret Reynard filed the False Claims Act lawsuit on behalf the federal government, accusing Dr. Yasin Khan, Dr. Elizabeth Khan, Dr. Dong Ko, Westfield Hospital, Lehigh Valley Pain management, and affiliated entities of overcharging government programs and charging for services that did not qualify for reimbursement.

According to the complaint, the defendants submitted the false claims to Medicare, Federal Employees Health Benefits, and Workers’ Compensation programs.

Ms. Maynard alleged in her complaint that from July 1, 2007, through December 31, 2013, the defendants billed the government programs  and received reimbursement for services performed by non-physicians as under the supervision of physicians when, in fact, supervising physicians were away from the office or unable to supervise for other reasons.

Billing services as “incident to” a physician’s supervision commands a higher reimbursement rate from government health care programs than billing those same services without physician supervision.

Because physicians were not available to provide the supervision that the government programs required, Ms. Reynard alleged that the defendants’ government billings were improper and resulted in false claims.

The defendants agreed to pay the U.S. $690,441 to resolve the allegations. As part of the settlement agreement, they also agreed that they will not bill federal health care programs for any “incident to” services provided by non-physician caregivers at the higher rate regardless of whether the claims could be billed properly in that manner.

Ms. Reynard will receive 18 percent, approximately $124,000, of the total recovery as an award for her role in exposing the improper billings.

Source: U.S. Attorney’s Office, Eastern District of Pennsylvania