Roanoke business will pay more than $2M in health care fraud case

Published: Mar. 2, 2021 at 1:57 PM EST
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ROANOKE, Va. (WDBJ) - A $2.1 million civil suit has been finalized against a Roanoke-based medical practice that pleaded guilty last year to criminal health care fraud.

Allergy and Asthma Associates Inc. [AAA], a family-owned practice, billed Medicare and Virginia Medicaid more than $600,000 for asthma treatments it did not purchase or improperly administered to patients, according to Acting US Attorney Daniel Bubar and Virginia Attorney General Mark Herring.

According to court documents, between January 2010 and September 2017, AAA submitted improper billings to Medicare and Medicaid for Xolair, an asthma treatment sold in single-use vials. Due to the nature of the drug, many patients receive doses of the drug that require health care providers to administer a partial vial of the drug, according to US Attorney Bubar. This results in leftover amounts of Xolair that are not administered to the patient. At times, Medicare and Medicaid allowed providers to bill Medicare Part B and Medicaid one time for an entire single vial of Xolair, which includes the administered quantity as well as the discarded quantity of the drug from a single-use vial, up to the amount listed on the vial’s label.

Bubar says in situations where a patient’s dose resulted in a leftover partial vial of Xolair, AAA administered the leftover amount to another patient and billed Medicare and Medicaid for administering this amount as if it were the entire single-use vial.

From January 2010 to September 2017, AAA billed Medicare $627,540 for Xolair that AAA did not purchase. In addition, AAA received 129 vials of Xolair from Medicaid, but it was not documented as being used for a Medicaid patient. These 129 vials represent an approximate loss to Medicaid of $88,878, according to Bubar.

Under the terms of the civil resolution, AAA will pay $2,149,607 to settle claims it violated the false claims act. $1,994,607 will be paid to United States government and $154,648 will be paid to the Commonwealth of Virginia.

“When a medical practice fraudulently bills our Medicare and Medicaid programs, it diverts funds from the most vulnerable in our communities and must be held accountable,” said Bubar. “Today’s civil resolution coupled with AAA’s criminal conviction in June marks the end of a lengthy investigation and demonstrates that we will work closely with our federal and state partners to hold providers responsible for healthcare fraud.”

“Individuals and health care providers who defraud our health care system are not only stealing from Medicare and Medicaid, but they are also stealing from taxpayers and they must be held accountable,” said Attorney General Herring. “I want to thank both our state and federal partners, as well as my hardworking Medicaid Fraud Control Unit, for their dedication and partnership on this case.”

“Every Medicare or Medicaid dollar paid wrongfully is money no longer available for crucially-needed health services,” said Maureen R. Dixon, Special Agent in Charge at the Office of Inspector General for the U.S. Department of Health and Human Services. “Working with our law enforcement partners we will continue protecting these valuable program funds.”

The practice released a statement through their legal counsel, Anderson Legal, that reads as follows:

“This is an agreed civil resolution in which Allergy and Asthma Associates worked cooperatively with the government to resolve and close a very complicated medical billing matter. When first brought to its attention, AAA immediately worked with the government to make this right and to continue its mission of providing excellent asthma and allergy care to its patients. In these difficult times, such work is more important than ever.

This resolution allows AAA to close this civil matter, and also by agreement with the government, for a new medical entity to emerge, without any interruption of service, to continue providing excellent care for its patients and their families.”

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