Atlanta pain clinic feels financial hurt after allegedly bending Medicare rules

Atlanta Medical Clinic (AMC) and its owner agreed to pay $250,000 to settle False Claims Act (FCA) (31 U.S.C. §3729 et seq.) allegations that the clinic billed Medicare for services performed by a suspended physician and for administering drugs that were not approved by the FDA.

Suspended physician

An AMC physician was suspended from the Medicare program in June 2013 for making false statements regarding his criminal history. Despite the suspension, AMC allegedly continued to claim and receive payment for medical services rendered by the physician. Because of the suspension, none of those services were eligible for Medicare reimbursement and, therefore, reimbursement claims related to those services constituted false claims. AMC allegedly circumvented the suspension by submitting claims for services performed by the physician as though they were performed by another physician.

Unapproved drugs

AMC also, allegedly, violated the FCA by seeking and obtaining reimbursement for a Canadian, non-FDA approved knee treatment drug—Orthovisc®. The alleged claims are false because Medicare does not cover the cost of foreign, non-FDA approved treatments.