The U.S. Attorney’s Office for the Northern District of Georgia announced that pain management physician Dr. Anthony Clavo has agreed to the entry of a consent judgment for $430,000 plus interest to resolve allegations that he violated the False Claims Act by billing Medicare, Medicaid, and TRICARE for medically unnecessary services. The federal government’s portion of the consent judgment is $322,407, and the State of Georgia’s portion is $107,593.
The government alleges that Dr. Clavo submitted or caused the submission of false claims to Medicare, Medicaid, and TRICARE for services that were not medically necessary or where there was insufficient information to determine the amount due the provider during the period from January 1, 2014 through June 22, 2015.
The settlement resolves allegations filed by Herretta Pickens and Teresa Williams, former employees of Dr. Clavo, under the qui tam, or whistleblower, provisions of the False Claims Act, which authorize private parties to sue for false claims on behalf of the United States and share in the recovery. The lawsuit was filed in the Northern District of Georgia and is captioned United States & State of Georgia ex rel. Herretta Pickens & Teresa Williams v. Southern Pain Institute, P.C. d/b/a Southern Spine & Pain Institute et al., No. 1:15-cv-2381 (N.D. Ga.). Ms. Pickens and Ms. Williams will receive a share of the settlement.
This settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by the Attorney General and the Secretary of Health and Human Services. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in this effort is the False Claims Act. Since January 2009, the Justice Department has recovered a total of more than $31.6 billion through False Claims Act cases, with more than $19.2 billion of that amount recovered in cases involving fraud against federal health care programs.