On
November 19, 2014, a federal qui tam lawsuit was settled in Los Angeles by the
U.S. Attorney’s Office civil division and physician Dr. Narinder S. Grewal and
his pain clinic, the Santa Clarita Surgery Center for Advanced Pain Management.
Dr. Grewal agreed that he and the clinic
would pay $1,087,176.09 to the United States for Medicare and Tricare billing and
$112,823.91 to the State of California for Medi-Cal billing.
This
is not a criminal case only civil. As a qui tam attorney, one common driving force that parties often settle these
cases, however, is to make sure that the U.S. Attorney’s Office does not use
the discovery process to build a criminal health care fraud case.
The
background is as follows. On April 16, 2008, a person (Chandana Basu) who did billing and collection for Dr. Grewal and his
clinic (who in qui tam cases gets called a “whistleblower”) had lawyers file a qui tam lawsuit against the doctor and
his clinic. On November 10, 2009, an
amended complaint was filed. Ultimately, the key issue was whether or not the United
States and/or the State of California would intervene in the case.
Basu’s
lawsuit alleged that Grewal and his clinic obtained improper reimbursements
from government-run health insurance programs, including Medicare, Medi-Cal and
Tricare, a federal health insurance program for military and related military
personnel. The lawsuit alleged that Grewal and his clinic submitted fraudulent
claims by “upcoding” medical services, which means that he allegedly submitted
bills that were not justified by the services that were actually provided.
Negotiations
ensued between the U.S. Attorney’s Office, the plaintiff biller’s attorneys and
the doctor’s attorneys. A settlement was reached. On November 19, 2014, the
U.S. Attorney’s Office filed a notice that it and the State of California would
intervene in some allegations in the first amended qui tam complaint and would
decline to intervene in other. As part of the settlement, the case was
dismissed with prejudice against the doctor and the clinic. The settlement
agreement is confidential but the payment amounts have been released.
The
False Claims Acts permit a private person to sue on behalf of the United States
and California, and to share in the proceeds of the suit. As a result of the
settlement announced today, Basu will receive a total of $204,000. The
settlement was announced after United States District Judge Andrew J. Guilford
unsealed the lawsuit. The parties asked the court to dismiss the suit.
Attorney Commentary: Billing
errors and upcoding can be serious issues. It is critical for practices with a
significant amount of governmental billing have a compliance plan in place in
order to avoid qui tam cases, audits for recovery and health care fraud
allegations. This is risk management and former employees will be the first to
file qui tam cases or call in an anonymous complaint to Medi-Cal, Medicare or
Tricare.
Posted
by Tracy Green, Esq.
Phone:
213-233-2260
