Danville business and owner to pay settlement in Medicare claims case

Medicare(Source: MGN)
Published: Jul. 26, 2022 at 3:14 PM EDT
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DANVILLE, Va. (WDBJ/US Attorney’s Office) - A Danville business and its owner have agreed to pay $310,000 to resolve allegations that they violated the False Claims Act and the Virginia Fraud Against Taxpayers Act by submitting false bills to Medicare and Medicaid.

Jacob Patterson, 66 of Danville, was a pharmacist who owned and operated Piedmont Infusion Services, a pharmacy-based infusion center that employed nurses and nursing assistants to provide patients with not only compounded prescriptions, but needle and catheter method medications ordered by their physicians, according to the US Attorney’s Office. Piedmont Infusion Services did not employ a physician or “physician extender,” such as a physician’s assistant, to provide patient care, said United States Attorney Christopher R. Kavanaugh.

From 2013 through the beginning of 2018, Patterson and Piedmont Infusion Services “falsely and knowingly billed Medicare and Medicaid for high-level office visits that simply did not occur,” said the US Attorney’s Office. “They consistently and improperly billed for CPT code 99215, which is only appropriate when a physician or other qualified medical professional provides evaluation and management of an established patient who presents problems of moderate to high severity. To be appropriate, the appointment must include at least two of these three key components: a comprehensive history, a comprehensive examination, and/or medical decision-making of high complexity. Patterson and Piedmont Infusion Services did not provide this care to patients, nor could they have appropriately done so because they did not employ a physician or other qualified medical professional to provide this care.”

In addition to falsely billing for non-existent high-level office visits, US Attorney Kavanaugh said, Patterson and Piedmont Infusion Services knowingly and fraudulently double-billed Medicare Part B for medications already billed to Medicare Part D.

“Providers who fraudulently bill Medicare defy basic requirements for their participation in the program and wrongfully attempt to collect taxpayer funds,” said Kavanaugh. “Here, because a former employee came forward, we learned that patients were not receiving the care that Jacob Patterson and Piedmont Infusion Services claimed to provide. They also did not receive some of the medications for which the government paid. Providers must honestly represent the drugs and services provided and follow the rules in place to protect patient safety. To do otherwise is fraud. My office will hold accountable anyone who seeks to cut corners by defrauding American taxpayers and risking harm to patients.”

A former employee of Piedmont came forward as a whistleblower and assisted the government in investigating this case, according to Kavanaugh. The civil settlement includes the resolution of claims brought under the qui tam, or whistleblower, provisions of the False Claims Act against Piedmont Infusion Services and Patterson. Under the qui tam provisions of the False Claims Act, a private party can sue on behalf of the government and share in any recovery.

“I am proud of my office’s great working relationship with the United States Attorney’s Office for the Western District of Virginia and the Department of Medical Assistance Services to combat abuse committed against the Virginia Medicaid program. Medicaid fraud can happen anywhere, to anyone. Together, we are committed to holding the bad actors that abuse Virginians accountable,” said Attorney General Jason Miyares.

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