DETROIT – U.S. Medical Management, LLC (“USMM”) and VPA, P.C. (“VPA”), providers of home-based healthcare services, have agreed to pay the United States $8.5 million to resolve allegations that USMM and VPA submitted to the Medicare program claims for payment for laboratory and diagnostic testing services performed from January 1, 2010 through December 31, 2015, which were not reasonable and necessary for the diagnosis or treatment of an illness or injury. The United States contends that the payments USMM and VPA received in connection with these claims were overpayments.
“USMM and VPA received millions of dollars from the United States for Medicare claims that were not eligible for reimbursement,” said Acting U.S. Attorney Saima Mohsin for the Eastern District of Michigan. “With this lawsuit and the accompanying resolution, USMM and VPA are being held to account for their improper receipt of Medicare claim reimbursements.”
Under the alternate remedy provision of the False Claims Act, 31 U.S.C. §§ 3729-3733, this settlement resolves allegations that were raised in five lawsuits filed under the qui tam, or whistleblower, provisions of that law. The False Claims Act permits private parties to file suit on behalf of the United States and to share in any recovery. Although the United States has not intervened in any of the False Claims Act allegations, under the alternate remedy provision of that law, the first-to-file whistleblower in this case will receive $1.53 million of the settlement amount.
The matter was handled by Assistant United States Attorney John Spaccarotella from the U.S. Attorney’s Office for the Eastern District of Michigan.
The five qui tam cases are docketed as United States ex rel. Irfan Mahmood v. U.S. Medical Management, LLC, et al., No. 2:10-cv-12022; United States ex rel. Lisa R. Hines v. VPA, P.C. d/b/a Visiting Physicians Association, et al., No. 14-cv-13385; United States ex rel. Muhammad S. Rais, M.D. v. U.S. Medical Management, Inc., et al., No. 2:12-cv-15518; United States ex rel. Pamela Henkels and Margaret Wisniewski v. U.S. Medical Management, LLC, et al., No. 2:14-cv-11944; and United States ex rel. Sian Ghosh v. U.S. Medical Management, LLC, et al., No. 18-10029. The claims resolved by the settlement are allegations only; there has been no determination of liability.
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