On August 2, the United States Attorney’s Office for the Northern District of Georgia announced that it had reached a $130,000 settlement with North Georgia Healthcare Center, Inc. (“NGHC”) to resolve allegations that it had violated the False Claims Act by causing the submission of medically unnecessary claims for various opioids to both the federal government and the state. Specifically, the complaint alleges that Dr. Gary Smith, a former NGHC physician, improperly prescribed opioids without appropriate medical review and judgment of medical necessity. The government alleged that Dr. Smith failed to meet with, evaluate, or review the charts of most of the patients for whom he prescribed opioids, instead allowing physicians assistants to see the patients. The government alleges that Dr. Smith merely signed a stack of prescriptions each week. The government further alleged that Dr. Smith only came into the office one afternoon every week. Dr. Smith also entered a settlement agreement with the government. He agreed to a voluntary 10-year exclusion from participation in all federal healthcare programs, meaning that neither he nor his future employers may obtain reimbursement for care provided to any patients insured under a government healthcare program, such as Medicare, Medicaid and Tricare. The government further alleged that, when made aware of the physician’s conduct, the CEO of NGHC failed to remedy the problems.
In its announcement, the government noted that the investigation into NGHC was the result of a qui tam suit filed by a relator. The government relies heavily on relators to reveal potential fraud to the government. Fraud, by its nature, is concealed from the prying eyes of regulators and government investigators. Relators are crucial in pealing back the shades and revealing fraud. The government provides relators with a portion of any recovery against individuals and entities about whom the relator has reported. There are also protections in place to prevent retaliation and ensure that employees are not hampered in bringing fraud to the attention of the government.
This investigation and the resulting settlement demonstrate the continued commitment of the government to combat the ongoing opioid crisis. Both political parties have signaled that combatting the unnecessary and over-prescription of opioids is crucial to ending the crisis throughout the country. In recent comments, Deputy Assistant Attorney General for the Department of Justice’s (“DOJ”) Civil Division Michael Granston indicated that fraud impacting the opioid crisis would be a focus of the DOJ going forward. For that reason, it is expected that similar investigations and settlements involving physicians and medical groups related to prescriptions for opioids will become more and more common.
The attorneys at Chilivis Grubman represent clients of all types and sizes in connection with False Claims Act investigations and qui tam litigation. If you need assistance with such a matter, please contact us today.