The United States Attorney for the Southern District of Alabama, Richard W. Moore has announced that Vaughan Regional Medical Center, a community hospital located in Selma, Alabama, along with emergency room physicians Dr. Sai S. Namburu, Dr. Phillip Alan Hicks, also of Selma, and Integrity Emergency Care, Inc.,  an entity owned and operated by Dr. Hicks have agreed to pay $1.45 million to resolve allegations that they violated the False Claims Act.

Whistleblower’s Case Results in Settlement and $275,000 Award

The settlement is a result of a qui tam False Claims Act case filed by Dr. Samuel Clemmons, who was represented by Frohsin Barger & Walthall in this case.  Dr. Clemmons alleged that the Defendants used unlicensed foreign medical graduates who were not fully licensed to independently cover shifts in the Vaughan Emergency Department.  Dr. Clemmons communicated with Vaughan and LifePoint Health about the illegal use of these residents in the Vaughan Emergency Department, yet no action was taken.  As the “whistleblower” in this case, Dr. Clemmons will receive $275,000 for bringing this case.

How the False Claims Act Rewards Whistleblowers

The False Claims Act entitles whistleblowers, also known as “relators,” who file False Claims act cases to between 15-30% of the government’s recovery.  Further, the False Claims Act provides for “treble damages” — meaning defendants who defraud the government are liable for three times the amount of money that the government was defrauded.  Successful relators are also entitled to receive attorney fees under the False Claims Act.

Government Investigation Corroborated Relator’s Allegations

Based on Dr. Clemmons’ qui tam Complaint, the Department of Justice launched an investigation into the allegations.  The Department’s investigation determined, from mid-2009 to March 31, 2012, residents were recruited from the UAB-Selma Family Medicine Residency Program to independently treat patients in Vaughan’s ER Department outside the course and scope of their residency program.  The residents were not licensed and credentialed physicians, yet were paid $50 per hour cash along with licensed emergency room physicians who were also paid an extra $50 per hour to co-sign the residents’ charts.  This illegal moonlighting was perpetuated by falsifying medical records and submitting false claims to Medicare as if the services were provided by licensed physicians.

Comments on the Successful Resolution

Frohsin Barger & Walthall managing partner, Jim Barger commented on the case: “We are proud to have represented the whistleblower, Dr. Sam Clemmons, a physician and healthcare professional who risked his career and business to expose these serious allegations of fraud targeting vulnerable citizens in a poverty-stricken area.”

Also commenting on the case, U.S. Attorney Richard W. Moore for the Southern District of Alabama, said: “[t]he significance of this case highlights the responsibilities of medical professionals and healthcare administrators to protect their patients from harm, and to prevent fraud against any federal health insurance program during the performance of their duties, [t]he citizens of the Selma community are entitled to quality healthcare administered by fully licensed physicians, and actions taken to put patient care in jeopardy and to circumvent state and federal law will not be tolerated.”

Derrick L. Jackson, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services commented: “Patients expect treatment by fully qualified medical professionals, and taxpayers should never be paying for healthcare provided fraudulently by an unlicensed physician–as alleged in this case.  We will aggressively work with our law enforcement partners in pursuit of those who would defraud government health programs and the individuals they serve.”

Frohsin Barger & Walthall would like to thank and congratulate the United States Attorney’s Office for the Southern District of Alabama and Assistant United States Attorney Deirdre Colson for achieving this settlement.  FBW would also like to thank the Department of Health and Human Services Office of Inspector General for its investigation in this matter.  Moreover, FBW would like to thank and congratulate our client Dr. Samuel Clemmons for his bravery in exposing this fraud as well as our co-counsel in this case: Brice Johnston and Brandy Lee of Red Mountain Law.

Read the full DoJ press release here.

If you have knowledge of fraud against government health care programs or unlicensed physicians billing government health care programs, please contact Frohsin Barger & Walthall.