Wednesday, November 26, 2014

California Pain Clinic & Physician Settle Federal Qui Tam Case For Allegedly Upcoding Medicare, Medi-Cal and Tricare – Case Filed by Former Biller Took 6 Years to Resolve

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.

Phone: 213-233-2260


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