U.S. Reaches a 1.25 Million USD Resolution with South Carolina Family Practice Clinics for Charging Unrequired Services to Federal Health Plans

U.S. Reaches a 1.25 Million USD Resolution with South Carolina Family Practice Clinics for Charging Unrequired Services to Federal Health Plans

Columbia, South Carolina– On 20th October 2021, Acting United States Attorney reported that Colonial Family Practice, LLC, a doctor-owned urgent and primary care facility with numerous clinics in South Carolina, agreed to a settlement of 1.25 million USD to resolve claims that it breached the False Claims Act by charging Medicaid, TRICARE, and Medicare for medically unrequired services.

The United States claimed that the Colonial Family Practice submitted allegations for medically unrequired nuclear stress examinations ordered by Dr. Lowder and Dr. David Whaley from 22nd February 2012 to 26th November 2019. Further, the United States claimed the practice systematically charged for unrequired Cystatin-C lab tests- a test to identify kidney dysfunction that is only remittable in a narrow set of patients. Colonial Family Practice purportedly added these examinations to a panel operated on most of its clients from 13th August 2013 to 29th November 2019.

The claims resolved came from two whistleblower cases– one by a Physician Assistant earlier hired by Colonial, and the other by a previous clinical manager at the clinic.

In the United States, ex rel. Debi Coker v. Colonial Family Practice, et al., No. 3:18-cv-00800-JMC, the previous clinical manager, claimed that from February 2021 to November 2019, doctors at the facility falsified symptoms in medical documents to back unrequired EKGs lab orders and radiology services.

In the United States, ex rel. James Fields v. Colonial Family Practice, et al., No. 3:19-cv-02703-JMC, the Doctor’s Assistant, claimed that, from August 2013 to November 2019, Colonial established a protocol to include Cystatin-C lab tests to its Basic Metabolic Panel, which resulted in systematic charging for medically unrequired Cystatin-C tests.

The proceeding was investigated by the South Carolina Attorney General’s Medicaid Fraud Enforcement Unit, the Department of Defense’s Defense Health Agency, and the United States Assistant Attorney Nancy Cote and Beth Warren.

The settlement and litigation of the matter demonstrated the government’s attempt at fighting health care fraud. One of the most potent tools in this attempt is the False Claims Act. Complaints and tips concerning possible waste, fraud, abuse should be reported to the Department of HHS-OIG.

The allegation settled by this agreement only claims. Colonial Family Practice, LLC does not confess to the wrongdoing or liability. 

Breaching the Anti-Kickback Act, the False Claims Statute, and the Controlled Substance Act,  is severely punishable by law. Additionally, conspiring to perpetrate health care fraud such as defrauding Medicaid, TRICARE, and Medicare programs is a serious offense. Any individual who commits these offenses breaks the law and is seriously penalized if found liable for the claims. Once indicted with these crimes, you should look for the best legal presentation or advice to pursue and protect your rights. Employ our professional team of top-rated criminal and defense attorneys if you want the finest legal assistance and presentation, which will result in attaining excellent results for your issue. At Health Care Fraud Group, we possess an experienced team of attorneys with tremendous skills and experience tackling Health Care fraud-related matters related to the Federal Healthcare Programs; they possess excellent knowledge about federal and civil matters. The defense attorneys are well known across the United States because of their exceptional professionalism and work while tackling health care fraud inquiries and cases. Our attorneys are well-equipped with prior knowledge of every aspect of Health Care Fraud, medical, legal, and defense issues.

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