Healthcare Whistleblower Attorney Helps Secure $1.2 Million from Dr. Modh and PPM
Dr. Nehal Modh, who owns and runs Progressive Pain Management (PPM) in Festus, Missouri, has settled with the U.S. government for $1.2 million over claims of submitting false information to Medicare and Missouri Medicaid. This case began when a former PPM employee, Donna Chronister, filed a qui tam lawsuit, showing just how important whistleblowers are in the fight against healthcare fraud.
False Claims Allegations and Settlement Details
On June 12, 2024, the Department of Justice announced a settlement regarding allegations against Dr. Modh and PPM. The accusations included falsely claiming to use ultrasound guidance for pain injections, submitting false claims for facet joint injections that didn’t meet billing requirements, and coding claims improperly to get extra reimbursements.
As part of the settlement, Dr. Modh and PPM will pay the U.S. $1.2 million, which includes $600,000 in restitution doubled under the False Claims Act’s penalty provisions. Whistleblower Donna Chronister will receive $177,707 as a reward for her crucial role in exposing the fraudulent activities.
Significance of the Case
This case highlights how crucial the FCA is in fighting healthcare fraud. By giving whistleblowers a voice and hitting fraudsters with hefty fines, the FCA acts as a strong deterrent and keeps our healthcare system honest.
The positive outcome of this case also shows how effective the qui tam provisions of the FCA are. These provisions let private citizens sue on behalf of the government and get a cut of the recovered funds. This setup encourages people to report fraud, protecting taxpayer money and ensuring healthcare resources are used properly.
SIMILAR HEALTHCARE FALSE CLAIMS ACT CASES
- Wisconsin Pain Management Companies Settlement: In 2014, several Wisconsin-based pain management companies settled False Claims Act allegations. The companies were accused of billing Medicare for medically unnecessary urine drug tests and for tests not actually performed.
- New Jersey & New York Pain Management Clinics Settlement: In 2021, several pain management clinics and their owner in New Jersey and New York settled a whistleblower lawsuit for $7.4 million. The whistleblower alleged that the clinics performed unnecessary procedures and billed for services not rendered.
The Future of Healthcare Fraud Enforcement
As the healthcare industry keeps changing, so do the ways people commit fraud. This case reminds us that we must stay alert to fight healthcare fraud. It also shows how important healthcare fraud attorneys and healthcare whistleblower attorneys are in exposing fraud and holding healthcare providers accountable.