Houston Clinics Pay $4.3 Million to Settle Doctor’s False Claims Lawsuit over Medicare Bills
December 4, 2013
HOUSTON – The operators of a network of wound care clinics have paid $4.3 million to the federal government to settle claims that they billed Medicare for treatment by unqualified therapists, ending a lawsuit by a Houston doctor who blew the whistle on them.
Dr. Caroline Fife, a specialist in wound care and professor at the University of Texas Medical School in Houston, sued the Lymphedema & Wound Care Institute of Texas Inc. in 2011 after finding some of her patients were named in Medicare bills she thought were fraudulent.
Her lawsuit was filed under the federal False Claims Act, which allows citizens to sue on behalf of the government to stop fraud. The law allows Dr. Fife to receive 19 percent of the proceeds of the settlement.
The suit was filed by lawyer Joseph Ahmad, a founding partner in the Houston complex commercial litigation law firm Ahmad, Zavitsanos, Anaipakos, Alavi & Mensing P.C., or AZA.
The settlement was featured in a Law360 story “Texas Physical Therapy Clinics Reach $4.3M FCA Deal” (subscription required). The story said the wound care group allegedly reaped over $165 million in fraudulent Medicare reimbursements for treating people with lymphedema, a serious type of fluid retention. The clinics allegedly used unqualified massage therapists to do physical therapy, the story said.
“Suits like this are a major win-win. A concerned citizen like the doctor can stop fraud, the government can get some of its money back, and the private citizen who stuck her neck out and helped make the case gets a percentage of the fees as well,” says Mr. Ahmad, who has handled many such citizen whistle-blower cases.
The U.S. Attorney’s Office for the Southern District of Texas released this press release about the settlement this week.
Specifically, the Lymphedema & Wound Care Institute paid the United States $4.3 million to settle claims they violated the Federal False Claims Act by submitting claims to Medicare for physical therapy treatments provided by unqualified therapists. One of the individuals involved in the clinic group will be barred from participating in federal health benefit programs for 10 years. The clinic group will now run under an integrity agreement to be monitored by the government.
This settlement was approved by U.S. District Judge Ewing Werlein Jr. The case is U.S. ex rel. Fife et al. v. Lymphedema & Wound Institute Inc. et al., case No. 4:11-cv-00271, in the Southern District of Texas.
Ahmad, Zavitsanos, Anaipakos, Alavi & Mensing P.C., or AZA, is a Houston-based law firm that is home to true courtroom lawyers with a formidable track record in complex commercial litigation, including energy, intellectual property, securities fraud, construction and business dispute cases. AZA is recognized by U.S. News & World Report and The Best Lawyers in America as one of the country’s best commercial litigation firms in the 2014 listing of the nation’s leading law firms. National corporate counsel named AZA one of the country’s best in client service among law firms serving the Fortune 1000. AZA has been hired on many occasions by the same companies the firm has prevailed against at trial. Read more at https://www.azalaw.com.