DANVILLE, Va. (WFXR) — The Department of Justice (DOJ) announced on Tuesday that Piedmont Infusion Services in Danville, along with its owner, have agreed to pay $310,000 after being accused of violating the False Claims Act and the Virginia Fraud Against Taxpayers Act by submitting false bills to Medicare and Medicaid.
According to the department, a 66-year-old Jacob Patterson owned and operated Piedmont Infusion Services, a pharmacy-based infusion center along Mall Drive that hired nurses and nursing assistants to provide patients compounded prescriptions, as well as needle and catheter method medications ordered by their physicians.
However, the DOJ says Piedmont Infusion Services did not employ a physician or “physician extender,” such as a physician’s assistant, to provide patient care.
From 2013 through the beginning of 2018, officials say that Patterson and Piedmont Infusion Services both falsely and knowingly billed Medicare and Medicaid for high-level office visits never happened.
According to the DOJ, Patterson and his facility “consistently and improperly billed for CPT code 99215, which is only appropriate when a physician or other qualified medical professional provides evaluation and management of an established patient who presents problems of moderate to high severity. To be appropriate, the appointment must include at least two of these three key components: a comprehensive history, a comprehensive examination, and/or medical decision-making of high complexity. Patterson and Piedmont Infusion Services did not provide this care to patients, nor could they have appropriately done so because they did not employ a physician or other qualified medical professional to provide this care.”
Besides falsely billing for non-existent high-level office visits, Patterson and Piedmont Infusion Services also knowingly and fraudulently double-billed Medicare Part B for medications already billed to Medicare Part D, the department says.
“Providers who fraudulently bill Medicare defy basic requirements for their participation in the program and wrongfully attempt to collect taxpayer funds,” said U.S. Attorney Christopher R. Kavanaugh. “Here, because a former employee came forward, we learned that patients were not receiving the care that Jacob Patterson and Piedmont Infusion Services claimed to provide. They also did not receive some of the medications for which the government paid. Providers must honestly represent the drugs and services provided and follow the rules in place to protect patient safety. To do otherwise is fraud. My Office will hold accountable anyone who seeks to cut corners by defrauding American taxpayers and risking harm to patients.”
“I am proud of my office’s great working relationship with the United States Attorney’s Office for the Western District of Virginia and the Department of Medical Assistance Services to combat abuse committed against the Virginia Medicaid program,” Attorney General Jason Miyares said. “Medicaid fraud can happen anywhere, to anyone. Together, we are committed to holding the bad actors that abuse Virginians accountable.”
A former employee of Piedmont Infusion Services came forward as a whistleblower and assisted the government in investigating this matter. The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act against Piedmont Infusion Services and Patterson. Under the qui tam provisions of the False Claims Act, a private party can sue on behalf of the government and share in any recovery. The qui tam case is captioned United States ex rel. Knowles v. Piedmont Infusion Services, Inc. and Jacob Patterson, Civil Action No. 4:17-CV-00082 (W.D. Va.).Statement released on July 26, 2022 by the U.S. Attorney’s Office for the Western District of Virginia
Assistant U.S. Attorney Sara Bugbee, along with Assistant Attorneys General Ray Bowman and Caitlyn Huffstutter in the Medicaid Fraud Control Unit of the Virginia Attorney General’s Office, reportedly handled this case.
According to officials, though, “The claims resolved by the settlement are allegations only and there has been no determination of liability.”