A physician, his son and their medical practice agreed to pay the U.S. $980,000 to resolve allegations arising from the False Claims Act. The pair allegedly submitted medically unnecessary urine tests to receive additional payments.
The claim arose from a new U.S. Attorney’s office effort, which reviews Medicare billing data. When the unit discovered the irregularities, the matter was further investigated by the Department of Health and Human Services and the U.S. Railroad Retirement Board.
The physician, Dr. Melvin Gonzaga, M.D., established an anesthesiology and pain management clinic in LaVale, Maryland. He named the practice group Gonzaga Interventional Pain Management (GIPM), and his son, Rommel Gonzaga, joined it as the chief executive officer.
Allegations state that from January 1, 2016, through March 1, 2019, GIPM billed Medicare, Medicaid, and the Railroad Retirement Board for numerous urine drug tests (UDTs). It ran both presumptive and definitive tests. Presumptive tests are the first step in determining whether the patient has illicit substances in their body. The definitive tests identify specific drugs. No one ordered these tests, and GIPM blanket-tested all patients for over 22 drug classes.
Suspicions continued to rise because patients received opioids and other controlled substances for pain. GIPM didn’t change prescriptions even if patients showed signs of addiction.
The claims never went beyond the allegation stage. So, the settlement reflects the best interests of GIPM and the U.S. government. It isn’t an admission of liability or a concession by the U.S. Attorney’s Office.
Healthcare billing fraud is too common, and it often takes whistleblowers to reveal it. A knowledgeable attorney from Kardell Law Group can guide you through the process and help you secure the best protections under the law. Call our office today to schedule a consultation.