Dr. Nehal Modh, owner of Progressive Pain Management (PPM) in Festus, has reached a settlement with the U.S. government to repay money he and his business collected from filing false claims to Medicare and Missouri Medicad, the U.S. Attorney’s Office announced.
As part of the settlement that was announced on Tuesday, June 11, Modh and PPM will repay the U.S. $1.2 million, consisting of $600,000 in restitution doubled under the False Claims Act (FCA).
The settlement resolved allegations that Modh and his business falsely indicated to both Medicare and Missouri Medicaid that ultrasound guidance was used on certain pain management injections, submitted false claims for payment for facet joint injections that did not meet billing substantiation requirements and improperly coded claims for payment to receive excess reimbursement, the U.S. Attorney’s Office reported.
The allegations were brought under the whistleblower provisions of the FCA by Donna Chronister, a former employee of PPM. Chronister will receive $177,707 of the proceeds from the settlement, according to the U.S. Attorney’s Office.
“We thank the whistleblower for her courage to bring her concerns forward,” U.S. Attorney Sayler A. Fleming for the Eastern District of Missouri said in the settlement’s announcement.
Chronister was a receptionist at PPM from May 2013 to September 2018. She left the business because she was “uncomfortable with the fraudulent and unethical billing practices” done by Modh, office manager Jeannine Yeast and PPM, according to court documents.
Yeast also worked for USL, a laboratory in California, and she would send urine samples to the laboratory to double bill federal healthcare programs for testing already performed by PPM, court documents said.
Ultrasound machines at PPM did not have power cords and didn’t function between May 2013 to September 2018. However, in 2015, PPM submitted 329 bills to Medicare and Medicaid to be reimbursed for ultrasound-guided injections that were performed without the use of the machines, court records show.
Patients also received opioid injections for pain more than once every three to four months, as recommended, between May 2013 to September 2018, according to court documents.
PPM also fraudulently billed for pain management exam services performed by a nurse practitioner instead of Modh. PPM should only have submitted bills to Medicare at 85 percent of the value of the service because it was administered by a nurse practitioner, but instead, the company submitted bills for 100 percent of the service fee, court records show.
The nurse practitioner worked at PPM from January 2018 to June 2019 and resigned when finding out about the billing practice. The nurse practitioner called Chronister on July 7, 2019, and told her of the fraudulent billing practice, according to court documents.
"Health care fraud is a serious problem that costs taxpayers millions in wasted dollars while often depriving vulnerable beneficiaries of the care and support they need," said Linda T. Hanley, special agent in charge from the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). "We will continue to aggressively investigate these cases in an effort to eliminate the corruption in our health care system."
This civil settlement was a result of the combined work of the U.S. Attorney’s Office for the Eastern District of Missouri, HHS-OIG’s Office of Investigations and Office of Audit, the Missouri Attorney General’s Medicaid Fraud Control Unit and the FBI.