Case law for suspended physicians
At least two physicians incurred large FCA
settlements in 2017 for billing for services provided by suspended or excluded providers.
As noted above, Dr. Dembowski’s $250,000 settlement was, in part, due to billing for services
performed by a physician who was suspended
from the Medicare program.
On September 27, 2017, Edison Adult Medical
Daycare, its former owner (Dr. Dinesh Patel),
and its current owners (Daxa Patel and
Satish Mehtani) agreed to pay $2.72 million
to resolve FCA allegations that Edison billed
and received Medicaid payments while Dr.
Patel was excluded from Medicaid. 18 Because
the current owners billed Medicaid with full
knowledge of Dr. Patel’s exclusion, they were
also held liable for the false claims.
The DOJ’s continued investigation and prosecution of individual physicians highlight the
need for physician practices to have a comprehensive compliance program. Physicians
should consult the Department of Health and
Human Services’ Office of Inspector General’s
(OIG) Compliance Program for Individual and
Small Group Physician Practices19 and the OIG
Work Plan20 when developing their compliance
plans with counsel.
1. Squire Patton Boggs: “Doctors Personally Paying More False Claims
Settlements” Triage Health Law Blog; November 9, 2017. Available at
2. U.S. Department of Justice: Sally Quillian Yates: Individual
Accountability for Corporate Wrongdoing (The Yates Memo), 2015.
Available at bit.ly/2t SoJh8.
3. U.S. Attorney’s Office (USAO) Eastern District of Kentucky, press
release: “Pain Management Physician Resolves False Claims Act
Allegations” Feb. 1, 2017. Available at bit.ly/2A99MKt.
4. Ibid, Ref 1.
5. Ibid, Ref 3.
6. USAO Southern District of Florida, press release: “Dr. Gary Marder
and the United States Consent to a Final Judgment of Over $18
Million to Settle False Claims Act Allegations” February 7, 2017.
Available at bit.ly/2h Xp TjB.
7. USAO District of New Jersey, press release: “Cardiologist Admits
Billing Veterans Affairs for Hundreds of Bogus Medical Procedures”
August 16, 2017. Available at bit.ly/2Bqk2vB.
8. USAO Western District of Oklahoma, press release: “Oklahoma
Doctor Agrees to Pay $580,000 to Settle Allegations of Submitting
False Claims to Medicare” August 28, 2017. Available at
bit.ly/2i Wh Sw5.
9. USAO Southern District of Texas, press release: “Former President
of Harris County Medical Society and Affiliated Facilities Settle
Allegations of Medicare Fraud” October 11, 2017. Available at
10. USAO District of Connecticut, press release: “Norwich Podiatrist
Pays $35,000 to Settle Allegations under the False Claims Act”
September 27, 2017. Available at bit.ly/2Ad0HAg.
11. USAO Northern District of New York, press release: “Syracuse Area
Medical Practice to Pay Nearly $2 Million to Resolve False Claims
Act Exposure” October 3, 2017. Available at bit.ly/2zGwREJ.
12. USAO Middle District of Florida, press release: “Owner of Tampa
Parathyroid Practice Agrees to Pay $4 Million to Resolve False
Claims Act Allegations” July 24, 2017. Available at bit.ly/2i91Kdm.
13. USAO Eastern District of Tennessee, press release: “Physician and
Wife to Pay $1.2 Million to Settle False Claims Act Allegations that
They Billed Medicare and Medicaid for Unapproved Drugs,” June
27, 2017. Available at bit.ly/2n74WYJ.
14. USAO Northern District of Georgia, press release: “Atlanta Pain
Clinic and its owner agree to pay $250,000 to resolve allegations
that they violated the False Claims Act,” August 2, 2017. Available at
15. Ibid, Ref 9.
16. U.S. Department of Justice, press release: “South Carolina Family
Practice Chain, Its Co-Owner, and Its Laboratory Director Agree to
Pay the United States $2 Million to Settle Alleged False Claims Act
Violations,” September 11, 2017. Available at bit.ly/2A9cZt2.
17. USAO Southern District of New York, press release: “Doctor and
Four Executives Plead Guilty in $30 Million Scheme to Defraud
Medicare and Medicaid,” November 14, 2017. Available at
18. USAO Dist. of New Jersey, press release: “Adult Day Care Facility
Agrees to $2.72 Million Settlement to Resolve Allegations of
Violating False Claims Act,” September 27, 2017. Available at
19. Available at 1.usa.gov/1np3hDY.
20. Available at bit.ly/2yFAkl M.