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Florida clinic to pay $24.5 million to settle overbilling claims, lying to COVID relief program

A picture shows a French general practitioner with a stethoscope in a doctor’s office in Bordeaux January 7, 2015. French doctors are protesting against a new health reform bill which would introduce a third-party payment system. Picture taken January 7, 2015. REUTERS/Regis Duvignau (FRANCE – Tags: HEALTH POLITICS)

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  • Physician Partners of America accused of tricking doctors into ordering unnecessary tests
  • The company’s CEO denies any wrongdoing

(Reuters) – A Florida-based pain clinic operator, along with its founder and chief medical officer, has agreed to pay $24.5 million to resolve claims that it billed federal health programs for unnecessary services, the US Department of Justice announced on Tuesday.

the regulation also resolves allegations that Physician Partners of America LLC (PPOA) falsely certified that it was not engaged in illegal activity in order to obtain a $5.9 million loan from the federal Paycheck Protection Program relief COVID-19.

PPOA CEO Mark Wade denied in a statement any wrongdoing on the part of the company and said the deal “completes a difficult and lengthy process”.

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The settlement stems from four lawsuits filed between 2018 and 2020 under the False Claims Act, which allows whistleblowers to sue private entities on behalf of the United States and receive a share of any recovery.

Whistleblowers and the federal government claimed that the PPOA, Founder Rodolfo Gari and Chief Medical Officer Abraham Rivera billed Medicare for unnecessary psychological, genetic and urine screening tests. They said the company illegally induces doctors to order tests by paying them a share of the revenue they bring in.

Pamela Brecht of Pietragallo Gordon Alfano Bosick & Raspanti, plaintiffs’ attorney in one of the whistleblower cases, said the PPOA told her doctors to order unnecessary urine drug tests, apparently to reduce the risk of opioid abuse.

His clients, physician Sheldon Cho and Dawn Baker, a recruiter who worked with the company, had filed a similar lawsuit over allegedly unnecessary urine tests against another clinic operator and its private equity owner, although that the case was dismissed last week for reasons unrelated to its merits.

Brecht said she believed the practice was widespread.

“I don’t know if we’ve seen the end or if we’re still in the middle of this abuse of urine toxicology testing,” she said.

The first whistleblower case was filed in 2018 by consultant Donald Haight, whose widow pursued the case after his death last year.

“Don Haight was convinced that PPOA’s billing practices were wrong,” said Emily Stabile of Phillips & Cohen, Haight’s attorney. “We are sad that he is not with us to see this positive result.”

Lawyers for the other whistleblowers, Doctors Venus Dookwah-Roberts and Michael Lupi, could not immediately be reached.

The whistleblower cases are Haight v. Physician Partners of America LLC, No. 8:18-cv-00267; Baker v. Physician Partners of America LLC, No. 8:19-cv-00902; Lupi c. Physician Partners of America LLC, No. 8:19-cv-02375; and Dookwah-Roberts v. Physician Partners of America LLC, No. 8:20-cv-00541, all in U.S. District Court for the Intermediate District of Florida.

For the government: David Tyler of the Civil Division of the United States Department of Justice; and Assistant U.S. Attorney Lindsay Saxe Griffin for the Central District of Florida

For Haight: Colette Matzzie and Emily Stabile of Phillips & Cohen

For Cho and Baker: Pamela Brecht and Marc Raspanti by Pietragallo Gordon Alfano Bosick & Raspanti

For Lupi: T. Christopher Tuck of Richardson, Patrick, Westbrook & Brickman

For Dookwah-Roberts: Richard Rose and Leah Gerbitz of Miller & Martin

For PPOA and Gari: Laurence Freedman of Mintz, Levin, Cohn, Ferris, Glovsky and Popeo

For Rivera: John Lauro of Lauro Law Firm

Read more:

Whistleblowers Can’t Sue Private Equity Firm Behind Medicare Billing for Drug Tests

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