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Virginia Pain Management Practice settles False Claims Act case

By Jeffrey J. Downey, Attorney, practicing in Virginia, Maryland and the District of Columbia


Richmond, Virginia – A Virginia based pain management practice, Physical Medicine Associates, LTD. settled a federal case in April of 2019, for allegedly billing for services as “incident to” a physician’s service, with the services having been performed by nurses and physician assistants.   The lawsuit also alleged that the Defendants submitted claims for urine drug tests that were in violation of the Stark Law and Antikickback Statute.   The whistleblower, a former employee of Physical Medicine Associates LTD, is eligible to receive 18% of the $3.29 million settlement reached by the parties. The settlement resolves a lawsuit filed in the U.S. District Court for the Eastern District of Virginia by a former physician assistant under the qui tam, or whistleblower, provisions of the False Claims Act. Under the Act, private citizens, known as Relators, can bring a suit on behalf of the United States and share in any recovery. Under the False Claims Act, relators are awarded 15 to 25 percent of the proceeds of the settlement amount depending on the level in which the whistleblower substantially contributed to the recovery.

It is not uncommon to see certain medical facilities upcoding billing services, explains whistleblower attorney Jeffrey J. Downey.   The Government provides incentives to whistleblowers who come forward with information that leads to a successful prosecution involving healthcare fraud.   Many of these cases can take years to prosecute, explains Downey.   It is important that patients or their family’s carefully review Medicare Explanation of benefit (EOBs) forms for suspicious billing activity.

Serving clients in Virginia, Maryland and the District of Columbia. Address: 8270 Greensboro Drive, Suite 810, McLean, VA, 22102, Phone 703-564-7318. On the web at www.jeffdowney.com.

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