The United States filed suit in U.S. District Court for the Southern District of Illinois against General Medicine, P.C. (“General Medicine”), Thomas M. Prose, M.D. – the owner of General Medicine, and seventeen related corporate entities owned by Prose. In a 96-page complaint, the government alleges Defendants violated the False Claims Act in a widespread healthcare fraud scheme involving the submission of thousands of false claims to the Medicare program. Since 2016, Medicare has paid defendants over $40 million dollars.
General Medicine and the other defendant companies owned by Prose are based in Novi, Michigan and employed physicians and nurse practitioners to treat patients in nursing homes and assisted living facilities in numerous states, including Illinois and Missouri. The government’s complaint alleges Defendants knowingly billed Medicare for visits with facility residents that were not medically necessary, did not meet the requirements of the billing codes, or were not performed at all. As alleged in the complaint, these visits resulted from General Medicine directing their physicians and nurse practitioners to meet visit quotas and perform numerous patient visits and assessments each month without any consideration as to whether the patients needed the services. Defendants also allegedly submitted inflated claims to Medicare using billing codes for complex, comprehensive visits when the providers spent only minimal time with patients. On multiple occasions, Defendants allegedly completed progress notes containing inaccurate information or embellished portions of the notes to bill the visits using codes with higher reimbursement rates.
“Vulnerable patients living in nursing homes and assisted living facilities should receive their medical care based on their medical needs, not needless visits manufactured to meet artificial corporate quotas,” said U.S. Attorney Steven D. Weinhoeft. “Billing Medicare for unnecessary and worthless services at inflated rates drains valuable taxpayer funding from the program and ultimately harms the patients who need it most. We will continue to work closely with our law enforcement partners to ensure federally funded healthcare programs are not abused.”
The investigation was a collaborative effort by the U.S. Attorney’s Office for the Southern District of Illinois, the U.S. Department of Health and Human Services – Office of Inspector General (HHS OIG), the Illinois State Police Medicaid Fraud Control Unit, the Federal Bureau of Investigation, the U.S. Department of Labor – Office of Inspector General, the U.S. Department of Labor – Employee Benefits Security Administration, the United States Postal Inspection Service, and the Department of Defense Office of Inspector General. The investigation has already resulted in former General Medicine nurse practitioner Jami Mayhew pleading guilty to healthcare fraud (see https://www.justice.gov/usaosdil/pr/madison-county-nurse-pactitioner-pleads-guilty-healthcare-fraud) and the indictment of Phillip Greene, a former General Medicine physician, in September 2021.
The United States is represented in the civil litigation by Assistant U.S. Attorneys Nathan Wyatt and Laura Barke. The case is captioned United States v. General Medicine, P.C., et al., No. 22-cv-00651-SMY (S.D. Ill.). The claims asserted in the complaint are allegations only, and there has been no determination of liability.
Members of the public who believe they may have information related to this or any similar schemes involving healthcare fraud in nursing homes are encouraged to contact law enforcement by calling the HHS OIG fraud hotline at 1-800-HHS-TIPS (1-800-447-8477) or by going online at https://oig.hhs.gov/fraud/report-fraud/.
Original source can be found here.
