JACKSONVILLE - The United States Attorney’s Office for the Middle District of Florida announced today that Bao Pham, D.O., and AccMed Healthcare Systems, LLC, d/b/a Florida Spine Care and Pain Center, have paid $448,794 to resolve allegations that they violated the False Claims Act by submitting false claims for medical services to the Medicare and federal Office of Workers Compensation (OWCP) programs. Pham is an osteopathic physician who focuses his practice on pain management and who, through Florida Spine Care and Pain Center, provides treatment to Medicare recipients for various conditions and to federal employees who are suffering various types of on-the-job injuries. Florida Spine Care and Pain Center is a Florida corporation located in Clay and Duval Counties in Florida.
Medicare benefits are available to eligible patients who are disabled or are aged 65 and older and who are enrolled in Part B of the Medicare Program to obtain benefits from participating healthcare providers. The federal OWCP benefits are available to federal civilian workers who are injured at work or who have acquired an occupational disease.
Today’s settlement resolves allegations that, between Jan. 1, 2004, and Dec. 31, 2008, Pham and Florida Spine Care and Pain Center submitted false Medicare and OWCP claims for non-reimbursable procedures and services by upcoding and unbundling medical services provided to beneficiaries of these two federal programs. The government alleged that Pham and Florida Spine Care and Pain Center upcoded a non-reimbursable procedure, performed in-office, as a surgical procedure and further routinely unbundled claims for certain pain management services in order to obtain reimbursement that would be higher than if properly submitted.
“This settlement represents another notable achievement in our battle against health care fraud in this district," stated A. Lee Bentley, III, Acting United States Attorney for the Middle District of Florida. “Civil health care fraud enforcement is, and will continue to be, one of our top priorities."
“Billing Medicare for one procedure but actually providing another, much cheaper procedure - as Pham allegedly did - is plain and simple fraud," said Christopher B. Dennis, Special Agent in Charge, Office of Inspector General (OIG), Department of Health and Human Services, Miami region. “When providers pad their pockets at Medicare’s expense, they can expect the OIG to investigate and hold them responsible."
“This settlement demonstrates the OIG’s commitment to investigate those who defraud the U.S. Department of Labor’s Federal Employees’ Compensation Program by billing for services that were not rendered. We will continue to work with our law enforcement partners to investigate these types of schemes," said Richard Walker, the Special Agent-in-Charge of the Atlanta Regional Office of the U.S. Department of Labor, Office of Inspector General, Office of Labor Racketeering and Fraud Investigations.
These allegations arose as a result of information received from a fraud investigator at a major health insurance carrier, which was simultaneously conducting an investigation into Dr. Pham’s billing practices.
This matter was handled by the U.S. Attorney’s Office for the Middle District of Florida, the Office of the Inspector General for the Department of Health and Human Services, the Office of the Inspector General for the Department of Labor and the Office of Inspector General for the United States Postal Service.
This matter was settled prior to filing suit by the United States of America. The claims settled by this agreement are allegations only; there has been no determination of liability.
Source: U.S. Department of Justice, Office of the United States Attorneys
