Feds, Medical Group Reach Settlement Over Fraud Claims

Jacksonville Journal-Courier (IL)

Nov. 29—A Quincy physicians' group will pay $500,000 to settle allegations that Medicare and Medicaid were billed for medically unnecessary procedures by one of its former doctors.

The agreement by Quincy Medical Group is the second involving allegations that insurance providers were billed for cardiac catheterization procedures between Aug. 1, 2012, and Aug. 30, 2018, in which the unidentified physician implanted medically unnecessary coronary arterial stents. Blessing Hospital agreed in August to pay $2.82 million to settle similar claims.

There has been no determination of liability by either group, according to the U.S. Attorney's Office for the Central District of Illinois.

"This second part of the combined over $3 million settlement is fair to both sides and demonstrates what should occur when alleged fraud is uncovered," acting U.S. Attorney Douglas J. Quivey said. "It is very important that all medical providers institute quality control and billing safeguards to protect both patient safety and billing integrity."

The U.S. Attorney's Office, the Department of Justice, the Inspector General's Office of the Department of Health and Human Services and Illinois State Police Medicaid Fraud Control Unit were involved in the investigation. Assistant U.S. Attorney John Hoelzer and Department of Justice senior trial counsel Laurie Oberembt represented the government during the settlement process.

"The physician performing these allegedly needless procedures exploited patients and the Medicare and Medicaid programs," said Curt L. Muller, special agent in charge with the Department of Health and Human Services Office of Inspector General. "We will continue to work with our law enforcement partners to protect the integrity of federal health programs and hold accountable those individuals or entities responsible for compromising our programs."

The federal government will receive about $459,000 of the settlement, with about $40,000 going to the state of Illinois and the remainder being divided between the states of Iowa and Missouri.