The Department of Justice was able to recover over $2 billion on behalf of taxpayers defrauded by healthcare providers engaging in misconduct against Medicare and Medicaid in fiscal year 2014. As part of this recovery, a Valencia, California-based doctor has agreed to pay $1.2 million to resolve allegations of unlawful billing procedures and the intentional submission of false invoices for reimbursement. The case was unsealed along with 68 other False Claims Act complaints, several of which involved similar healthcare fraud and billing scams.
Details of the Case Against Dr. Narinder S. Grewal
Amid growing concerns of questionable billing practices, a whistleblower lawsuit was filed against Dr. Grewal – a board certified anesthesiologist – by a former office manager and collections agent. Dr. Grewal operates the Santa Clarita Surgery Center for Advanced Pain Management at the Henry Mayo Newhall Hospital and provides a number of pain management options for patients with conditions like fibromyalgia and cancer. However, according to the complaint, Dr. Grewal was engaging in the routine practice of upcoding and charging for services never rendered – an all-too-familiar practice in the modern healthcare industry.
More specifically, the whistleblower alleged that Dr. Grewal and his associate physician staff would submit claims for reimbursement to Medicare and Medicaid for a procedure known as neuroplasty. This procedure involves the repair and restoration of nerve tissue and is considered a highly complex and costly operation. Allegedly, many of Dr. Grewal’s patients could have benefitted from a simpler and less costly procedure known as neurolysis, which destroys and eliminates damaged nerves through a series of injections and the introduction of radio frequencies. The decision to perform the neuroplasty procedure was allegedly medically unnecessary for many of Dr. Grewal’s patients, thereby triggering potential liability under the False Claims Act. The relator also contended that Dr. Grewal was not qualified to perform the neuroplasty procedure, which would also trigger False Claims Act liability when performed on Medicaid and Medicare recipients.
Settlement of claims
The settlement between the parties was announced on November 20, 2014, shortly after the complaint was unsealed by United States District Judge Andrew J. Guilford. The whistleblower is set to receive a sum of $204,000 for her willingness to come forward with allegations of healthcare fraud. The U.S. government opted not to intervene in this case, which is not uncommon considering the government only intervenes in about 25 percent of all False Claims Act cases.
The settlement was reached following a concerted investigation by the United States Attorney’s Office and the California Attorney General’s Office, in conjunction with the Department of Health and Human Services, Office of Inspector General, and the Department of Defense, Defense Criminal Investigative Service.