Danville, Va. (WDJ/U.S. Attorney’s Office) – A Danville business and its owner have agreed to pay $310,000 to settle charges alleging the False Claims Act and Virginia’s fraud against Medicare and Medicaid.
Jacob Patterson, 66, of Danville, was a pharmacist who owned and operated Piedmont Infusion Services, a pharmacy-based infusion center that employs nurses and nursing assistants to not only fill prescriptions for patients but also inject and catheterize medications prescribed by their doctors. According to the US Attorney’s Office. U.S. Attorney Christopher R. Kavanaugh said Piedmont Infusion Services does not employ a physician or “physician extension,” such as a physician assistant, to provide patient care.
From 2013 to early 2018, Patterson and Piedmont Infusion Services “falsely and knowingly billed Medicare and Medicaid for high-profile office visits that did not occur,” the U.S. Attorney’s Office said. “They consistently and improperly bill for CPT code 99215, which is appropriate only when a physician or other qualified medical professional is providing evaluation and management of an established patient presenting with moderate to severe complications. To be appropriate, the appointment must include at least two of these three key components: General history, general examination, and/or significant complexity of medical decisions.Paterson & Piedmont Infusion Services did not provide this care to patients, or did not retain a physician or other qualified medical professional to provide this care.
In addition to falsely billing for unnecessary high-level office visits, U.S. Attorney Kavanaugh said, Patterson and Piedmont Infusion Services knowingly and fraudulently double-billed Medicare Part B for Medicare Part D drugs.
“Providers who fraudulently bill Medicare are violating basic requirements for their participation in the program and are attempting to fraudulently collect taxpayer funds,” Cavanaugh said. “Here, we learned that patients were not receiving the care that Jacob Patterson and Piedmont Infusion Services said they were providing because a former employee had come forward. They did not get some of the medicines that the government had paid for. Providers must honestly represent the drugs and services they provide and follow applicable laws to protect patient safety. Doing otherwise is cheating. My office will hold accountable anyone who seeks to cut corners by defrauding American taxpayers and harming patients.
A former Piedmont employee came forward as a fraud and helped the government investigate this case, Kavanaugh said. The civil settlement in Man Tam, or Plaintiff, the provisions of the False Claims Act against Piedmont Infusion Services and Patterson. underneath Who Tam Under the provisions of the False Claims Act, a private party may sue on behalf of the government and share in any recovery.
“I am proud of the great working relationship my office has with the United States Attorney’s Office for the Western District of Virginia and the Department of Medicare Services to combat abuses in Virginia’s Medicaid program. Medicaid fraud can happen to anyone, anywhere. “Together, we are committed to holding accountable the bad actors who abuse Virginians,” said Attorney General Jason Myars.
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