United States Attorney Jacqueline C. Romero has announced a settlement involving Dr. Ghodrat Pirooz Sholevar and his company, Nueva Vida Multicultural/Multilingual Behavioral Health, Inc. The parties have agreed to pay $900,000 to address allegations of fraudulent billing practices related to Medicaid services. The claims were outlined in an amended complaint filed by the United States.
The complaint alleges that from January 15, 2009, through March 31, 2017, Nueva Vida submitted false bills for medication management appointments that did not meet the required minimum duration of 15 minutes. These appointments were reportedly shorter than necessary and were billed as full "units" despite their insufficient length. It is further alleged that Sholevar recorded inaccurate start and end times for these appointments, creating the appearance of compliance with Medicaid requirements.
According to the government, Sholevar and Nueva Vida disregarded Medicaid regulations concerning appointment durations despite being notified in an audit as early as 2004 about non-compliance issues. Despite regular recoupment actions by the Medicaid program administrator for improperly documented visits, the defendants allegedly continued their billing practices until Nueva Vida ceased operations in 2018.
U.S. Attorney Romero stated: “The defendants allegedly overbilled the Medicaid program at the expense of low-income Philadelphians, including children, who were seeking mental health services.” She emphasized that those seeking care deserved comprehensive services without shortcuts.
Maureen R. Dixon from the Department of Health and Human Services Office of Inspector General (HHS-OIG) remarked on the significance of Medicaid's role in providing mental health services and reiterated HHS-OIG's commitment to investigating fraud allegations alongside partners like the U.S. Attorney’s Office.
This case was resolved under the False Claims Act in U.S. District Court for Eastern Pennsylvania. The investigation involved efforts from both Assistant United States Attorneys Erin Lindgren and Gregory in den Berken as well as auditor George Niedzwicki.
While this settlement resolves specific allegations against Sholevar and Nueva Vida, it does not constitute a determination of liability.
