Summary Judgement Issued in Civil Case

Summary Judgement Issued in Civil Case Involving Hundreds of Fraudulent Medicaid/Tricare Bills

MACON, GA (STL.News) The District Court for the Middle District of Georgia entered an order partially granting summary judgment in favor of the United States and State of Georgia in U.S. ex rel Walthour v. Middle Georgia Family Rehab. Civ No. 5:18-cv-378-TES.

The order granted summary judgment on 808 false claims submitted by Middle Georgia Family Rehab (MGFR) and Brenda Hicks for services improperly billed to Medicaid and Tricare between Nov. 2, 2015, and June 18, 2020. Those improper services were billed under the names of a physical therapist and a speech therapist who were no longer employed by MGFR and therefore could not possibly have provided the services in question. U.S. District Judge “Tripp” Self, III issued the order on April 20.

In analyzing the question of whether MGFR knowingly submitted the false claims, the Court found that MGFR’s conduct “epitomizes ‘reckless disregard’ of the truth.” (ECF No. 52 at 30.) Specifically, the Court found that MGFR’s submission of 767 claims to Medicaid and Tricare over an eight-month period following the resignation of one physical therapist and the submission of 41 claims following the resignation of a speech therapist could not be characterized as an “honest mistake.” (ECF No. 52 at 30.)

Under the False Claims Act, the government is entitled to three times damages and civil penalties ranging from $5,500 and $11,000 for each identifiable claim submitted between Nov. 2, 2015 – July 31, 2016, and a range of $11,181 – $22,363 for violations committed after Jan. 29, 2018.

“Protecting the integrity of our nation’s health care programs that provide critical services for veterans, elderly and vulnerable people is imperative to ensure the continued good health of these very programs,” said U.S. Attorney Peter D. Leary. “Our office will pursue reports of medical facilities that file false claims, a choice that ultimately robs our citizens.”

The Court has ordered the parties to appear within 30 days for a hearing on the issue of damages. The hearing is scheduled for May 2 at 2:30 p.m. in Macon.

Assistant U.S. Attorneys Bowen Shoemaker and Taylor McNeill are handling this case for the Government.