Businesses in Savannah, Lyons, Vidalia, Statesboro and Augusta are among 412 charged defendants across 41 federal districts, including 115 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $1.3 billion in false billings.
Of those charged, over 120 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics.
On Thursday, the U.S. Departments of Justice and Health and Human Services announced the largest health care fraud enforcement action by the Medicare Fraud Strike Force.
Actions and allegations by the United States Attorney’s Office for the Southern District of Georgia included:
- Intervention for a civil settlement against Atlantic Foot & Ankle, P.C., a physician practice, as well as an owner of the practice, Dr. Melissa Robitaille. Atlantic Foot & Ankle and Robitaille were accused of submitting claims and receiving payment for services that did not qualify for payment by misrepresenting the services actually rendered.
- Allegations of one count of Health Care Fraud against Sherry McCormick, saying that from 2013 to 2015, McCormick defrauded Medicare, Tricare, and the Federal Employee Health Benefit Program of approximately $500,000 by submitting and causing the submission of fraudulent claims for medications that were not medically necessary and not prescribed by a doctor.
- A civil settlement with Allcare Pharmacy, a Lyons pharmacy, totaling $175,000. Based on the actions of its former employee, McCormick, the United States contended that Allcare Pharmacy submitted claims and received payment for prescriptions for compounded medications that were not medically necessary and not prescribed by a doctor.
- Reached a civil settlement with Ramachandra Paidi, M.D., a physician practicing out of Vidalia, totaling $303,950. The settlement resulted from an investigation by the Department of Health and Human Services, Office of the Inspector General, the State of Georgia, and the United States Attorney’s Office for the Southern District of Georgia. Based on its investigation, the United States contended that, on several occasions, Paidi submitted claims to Medicare and Medicaid for psychotherapy services for 24 hours or more of services in any given day.
- Reached a civil settlement with Medical Center Pharmacies of Statesboro and its owners, totaling $85,000. The settlement resulted from an investigation by the DEA and the United States Attorney’s Office for the Southern District of Georgia. Based on its investigation, Medical Center Pharmacies and certain pharmacists allegedly violated the Controlled Substances Act by negligently failing to make, keep, or furnish certain records regarding highly addictive Schedule II controlled substances, including opioids, as required by federal law.
A complaint, information or indictment is merely an allegation, and all defendants have are presumed innocent unless and until proven guilty. The claims resolved by civil settlements are allegations only; there has been no determination of liability. Investigations remain ongoing as to others arising out of these announced actions.
Acting United States Attorney James Durham said, “The Office will continue to hold accountable those who take advantage of federal health care programs and those who fail to act responsibly when prescribing or safeguarding opioids. Any such fraudsters or hucksters should steer clear of our district, or else expect to face jail time and substantial financial penalties for their acts.”