Oklahoma News: Oklahoma Orthopedic Company and Physicians Agree to Pay $670,000 to Settle Allegations of False Claims to Medicare, Medicaid, and Tricare

Oklahoma News: Oklahoma Orthopedic Company and Physicians Agree to Pay $670,000 to Settle Allegations of False Claims to Medicare, Medicaid, and Tricare

OKLAHOMA CITY, OA. – SOUTHWEST ORTHOPAEDIC SPECIALISTS, PLLC; ANTHONY CRUSE, D.O.; R.J. LANGERMAN, JR., D.O.; DANIEL J. JONES, M.D.; MEHDI ADHAM, M.D.; DEREK WEST, D.O.; BRIAN LEVINGS, D.O.; SHANE HUME, D.O.; BRAD REDDICK, D.O.; and KRISTOPHER AVANT, D.O., have agreed to pay $670,000 to settle civil claims stemming from allegations that they submitted false claims to Medicare, Medicaid, and Tricare, announced Robert J. Troester, Acting United States Attorney for the Western District of Oklahoma, and Mike Hunter, Oklahoma Attorney General.

Defendants Cruse, Langerman, Jones, Adham, West, Levings, Hume, Reddick, and Avant are physicians who practiced medicine at and held ownership in Southwest Orthopaedic.  The United States alleges that from January 1, 2012, through September 22, 2016, Southwest Orthopaedic and the individual defendants caused false claims to be submitted to Medicare, Medicaid, and Tricare for unnecessary medical procedures involving ultrasonic guidance for needle placement imaging supervision and interpretation.  The United States also alleges that from January 1, 2013, through December 31, 2015, Southwest Orthopaedic and Defendant Levings caused false claims to be submitted to Medicare, Medicaid, and Tricare for a surgery assistant who did not perform the services billed.

In order to resolve these allegations, Southwest Orthopaedic and the individual defendants have agreed to pay $670,000. Oklahoma will receive a portion of this total because of alleged false claims submitted to Medicaid.

This settlement resolves two of the allegations filed in a lawsuit by a whistleblower who formerly worked for Southwest Orthopaedic. The lawsuit was filed in federal district court in Oklahoma City under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private individuals to sue on behalf of the United States for false claims and to share in the recovery.  The Act also allows the government to intervene in the lawsuit.  In this case, the government intervened in the allegations resolved by this settlement. Other claims continue to be litigated.

In reaching this settlement, Southwest Orthopaedic and the individual defendants did not admit liability, and the United States and Oklahoma did not concede that their claims lack merit.  The agreement allows the parties to avoid the delay, expense, inconvenience, and uncertainty of litigating the case.

This case was investigated by the Federal Bureau of Investigation, the Medicaid Fraud Control Unit of the Oklahoma Attorney General’s Office, and the Defense Criminal Investigative Service.  It was prosecuted by Assistant U.S. Attorneys Ronald R. Gallegos and Scott Maule and Assistant Attorney General Christopher P. Robinson.

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SOURCE: news provided by JUSTICE.GOV on Friday, July 13, 2018.