WA (MI)- Eastern District of Michigan | Michigan Doctor to Pay $6.5 million to Resolve False Claims Act Allegations

MM Curator summary

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[MM Curator Summary]: Another bogus drug testing scam, and a whistleblower that made out pretty good.



Clipped from: https://www.justice.gov/usao-edmi/pr/michigan-doctor-pay-65-million-resolve-false-claims-act-allegations

DETROIT – A Michigan interventional pain management specialist, Rajendra Bothra, M.D., and two medical entities that he owned and operated, The Pain Center USA, PLLC, and Interventional Pain Center, PLLC, (collectively, “Defendants”) have agreed to pay $6,500,000 to resolve claims that they violated the federal False Claims Act, United States Attorney Dawn N. Ison announced today.

The settlement announced today resolves allegations that from January 1, 2015, to December 31, 2018, Defendants billed Medicare and Medicaid for excessive and medically unnecessary presumptive and definitive urine drug tests that were not relevant to their patients’ diagnosis or treatment, along with additional laboratory charges that were not separately billable with the urine drug tests. Additionally, Defendants are alleged to have billed Medicare and Medicaid for medically unnecessary moderate sedation services that were routinely performed in conjunction with interventional pain management procedures that did not require moderate sedation services. The government also alleges that Defendants frequently charged Medicare and Medicaid for expensive back braces that were medically unnecessary or otherwise ineligible for reimbursement.

“Our office remains steadfast in our commitment to protect federal health care programs, their beneficiaries, and taxpayers from fraud and abuse,” said U.S. Attorney Ison.

“This settlement underscores the important role that medical providers have in ensuring that the claims submitted to Federal health care programs are medically necessary,” said Mario M. Pinto, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General. “Our office remains committed to working with our law enforcement partners to ensure that health care providers who violate the False Claims Act are held accountable.”

“When healthcare providers manipulate the Medicaid and Medicare systems, it wastes resources meant to help those in need,” said Devin J. Kowalski, Acting Special Agent in Charge of the FBI’s Detroit Field Office. “This settlement brings to bear some economic justice by requiring those who orchestrated the fraud scheme to pay for their actions.”

The civil settlement includes the resolution of claims in two separate lawsuits brought by relators under the qui tam or whistleblower provisions of the False Claims Act. Under these provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. The two qui tam cases are captioned United States ex rel. Ronald Kufner et al. vs. The Pain Center USA PLLC, et al., No. 2:17-cv-11644 (E.D. Mich.) and United States ex rel. Hersh Patel vs. Interventional Pain Center, et al, No. 2:18-cv-12728 (E.D. Mich.). As part of the settlement, the relators will receive a combined payment in the amount of


The resolution obtained in this matter was the result of a coordinated effort between the U.S. Attorney’s Office for the Eastern District of Michigan, and the Michigan Attorney General’s Health Care Fraud Division, with assistance from the U.S. Department of Health and Human Services, Office of Inspector General, and the Federal Bureau of Investigations. Assistant U.S. Attorney Carolyn Bell Harbin represented the United States in this matter.

The investigation and resolution of this matter illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services at 800- HHS-TIPS (800-447-8477).