ROANOKE, Va. (WFXR) — Virginia Attorney General Mark Herring and acting U.S. Attorney Daniel P. Bubar announced on Tuesday the finalization of a $2.1 million civil resolution with Allergy and Asthma Associates, Inc. (AAA), a Roanoke-based, family-owned medical practice that billed Medicare and Virginia Medicaid more than $600,000 for expensive asthma treatments in did not purchase or improperly administered to patients.
In June 2020, AAA pleaded guilty in U.S. District Court in Roanoke to one count of criminal health care fraud.
“Individuals and health care providers who defraud our health care system are not only stealing from Medicare and Medicaid, but they are also stealing from taxpayers and they must be held accountable. I want to thank both our state and federal partners as well as my hardworking Medicaid Fraud Control Unit, for their dedication and partnership on this case.”Attorney General Mark Herring
Court documents indicate that between January 2010 and September 2017, AAA submitted improper billings to Medicare and Medicaid for Xolair, an expensive asthma treatment sold in single-use vials.
Due to the nature of the drug, many patients receive doses of the drug that require health care providers to administer a partial vial of the drug, resulting in leftover amounts of Xolair that are not administered to the patient.
Between that time, AAA billed Medicare $627,540 for Xolair that AAA did not purchase. Additionally, AAA received 129 vials of Xolair from Medicaid which is not documented as being used for a Medicaid patient. These vials represent an approximate loss to Medicaid of $88,878.
Under the terms of the civil resolution finalized last week, AAA will pay a total of $2,149,607 to settle claims they violated the false claims act.
Of that, $1,994,607 will be paid to the U.S. government and $154,648 will be paid to the Commonwealth of Virginia.