On August 21, 2020, the United States Attorney for the Southern District of Georgia announced that Brunswick-based Heller Family Medicine LLC (HFM) and its owner, Dr. Jennifer Heller, agreed to pay more than $5 million to the United States for false claims made to Medicare. Under a consent agreement approved in August, HFM will pay the United States $4.3 million in treble damages, while Dr. Heller will pay $700,000 in civil penalties.

The Government alleges Dr. Heller and HFM violated the False Claims Act by submitting claims to Medicare for implantable neurostimulators when their practice actually involved affixing an acupuncture device, a “P-Stim,” with adhesive behind a patient’s ear. Acupuncture devices, including the “P-Stim,” are not covered by the Medicare program for surgical neurostimulator procedures. Over a two-year period, Medicare paid HFM more than $1.4 million for “P-Stim” claims.

The attorney for Dr. Heller, Mike Khouri, stated that Heller is a victim; he asserts that the blame lies with the consulting company that advised Heller to begin using the acupuncture device and billing Medicare under the incorrect billing code.  According to Khouri, prior to implementing the allegedly fraudulent claims practice, Dr. Heller contracted with a consulting company that helped chiropractors develop additional sources of revenue. The consulting company recommended that Heller hire nurse practitioners and a medical director to bill healthcare providers for services that a chiropractor could not bill for herself. The consulting company then advised Heller to begin using the “P-Stim” devices and bill under the neurostimulator billing code. In her defense, Dr. Heller argued that she alerted Medicare as soon as she discovered the devices were billed under the incorrect billing code.

Dr. Heller will also continue to assist the United States in investigations of other practices that used the same consulting company, and Khouri has stated that Heller will become the plaintiff in a subsequent lawsuit against the company.  Khouri further alleged that the consulting company received kickbacks from the manufacturer and distributor of the acupuncture device and sold the devices to other M.D.s, chiropractors, and osteopaths. Other medical practices advised by the consulting company will be joining Heller as plaintiffs in the lawsuit.

Although Dr. Heller self-disclosed the incorrect billings, this settlement resolves a lawsuit that could have been brought by a private whistleblower under the qui tam provisions of the False Claims Act. Under the qui tam provisions of the False Claims Act, private whistleblowers with information about similar fraudulent claims to the U.S. government may bring a civil case on behalf of the United States. If successful, the Government can recover three times the amount the defendant fraudulently billed the government. Private whistleblowers are entitled to 15–30% of the Government’s recovery as well as their attorney’s fees.

 

If you have questions about medical billing fraud or the False Claims Act, contact Frohsin Barger & Walthall.

 

Read the full Department of Justice Press Release here.