We’ve provided you with lots of information and stories about cases in the past few months relating to whistleblowing and qui tam whistleblower cases. But this new suit is homegrown, and as much as $27 million is at stake.
Just days ago, in May, 2016, the U.S. Department of Justice (DOJ) brought a suit alleging that a Midlands family medical group practice has been committing fraud against the government for years by ordering unnecessary tests for Medicare patients, many of them blood and liver tests. The suit further alleges that Medicare paid Family Medicine Centers of South Carolina over $9 million in improper payments. The government has joined a qui tam whistleblower action that was initiated by a doctor who is a former employee of the practice. Damages of up to $27 million could be awarded if the suit is successful, because the court can triple the amount of damages for the final award.
Family Medicine Centers has six locations in the Columbia area, with 18 doctors who care for roughly 30,000 patients. It is one of the state’s biggest providers of primary care services.
The whistleblower, Dr. Catherine Schaefer, had her own practice of 3,000 patients in Columbia before she joined Family Medicine Centers in 2013. She worked extensively with Medicare and TRICARE patients in her solo practice and was therefore quite familiar with federal law regarding reimbursement. She brought her patients with her, but they soon began to complain to her about billing discrepancies.
In her suit, Dr. Schaefer alleged double billing, upcoding office visits (entering billing codes for medical procedures that result in a greater payment than if the correct billing code were used), and pressuring patients to have expensive testing done without the doctor’s investigating whether the tests were actually needed.
Dr. Schaefer spent seven months at Family Medicine Centers. During that time, she was warned repeatedly about not just going along with the billing system. She was finally fired for rejecting demands that she write doctor’s notes which would justify fraudulent charges.
U.S. Attorney Bill Nettles pointed out that the Medicare reimbursement of doctors hangs on honest billing. “The cornerstone of Medicare is that the government believes it can trust the doctor to not steal. We will continue to aggressively bring suit in cases of fraud against the government.”
Family Medicine Centers denies all charges. Its Medical Director, Dr. Stephen Serbin, said in a prepared statement, “Our practice firmly denies all of the allegations in this lawsuit, and will vigorously defend it. FMSC has always placed the interests of our patients above any self-interest, and maintains its commitment to the families of South Carolina.”
Dr. Schaefer is represented by Bert Louthian and Dick Harpootlian.