David J. Hickton, United States Attorney for the Western District of Pennsylvania, announced on August 30, 2016 that Dr. John P. Balko and Senior Healthcare Associates, a company owned by Dr. Balko, have agreed to pay the United States $930,000 to settle False Claims Act allegations.
The United States alleged that Dr. Balko violated the False Claims Act by submitting claims to Medicare for services provided to nursing home residents which were not medically necessary, not authorized or requested by patients, not supported by patient medical records, or were provided in reliance upon improper standing orders. Examples of such services included earwax removal procedures, podiatry and evaluation and management services. The government alleged these fraudulent billings occurred from 2006 to May 2015.
Dr. Balko and his company contracted with nursing homes in Pennsylvania, West Virginia, Ohio, Kansas, and Missouri to provide audiological services, podiatry and other healthcare for nursing home residents.
The case was investigated by the Office of Inspector General of the Department of Health and Human Services and prosecuted by the U.S. Attorney’s Offices of the Western District of Pennsylvania and Northern District of Ohio. The claims resolved by the settlement are allegations only, and there has been no determination of liability.
Under the qui tam provisions of the False Claims Act, whistleblowers with information about similar fraud against the 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. The whistleblower, who originally filed the qui tam case, is entitled to 15-30% of the government’s recovery as well as their attorney’s fees.
To report fraud, contact Frohsin Barger & Walthall.