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Volume XIII, Number 32


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Physician Partners of America Agrees To Pay $24.5 Million To Resolve False Claims Act Allegations

Physician Partners of America Agrees To Pay $24.5 Million To Resolve False Claims Act Allegations

Physician Partners of America LLC (PPOA), its founder, and its former chief medical officer agreed to pay $24.5 million to resolve FCA allegations raised in four qui tam lawsuits filed by current and former employees of PPOA and its affiliated entities.

PPOA allegedly billed federal healthcare programs for unnecessary medical testing and services and paid unlawful remuneration to its physicians. Specifically, the government alleged that PPOA required its physicians to order multiple urine drug tests without determining whether such testing was reasonable and necessary and before reviewing the results of initial testing to determine if additional testing was necessary. Federal healthcare programs were then allegedly billed for the highest-level urine drug testing by a toxicology lab affiliated with PPOA. According to DOJ’s press release, PPOA physicians were incentivized to order presumptive urine drug tests because they received 40% of PPOA’s profits from such testing in violation of the Stark Law. PPOA is also alleged to have required patients to receive genetic and psychological testing without any determination as to the reasonableness or necessity of such testing.

The government further alleged that PPOA falsely represented to the Small Business Administration that it was not engaged in any unlawful activity when it sought to obtain a $5.9 million Paycheck Protection Program loan. According to the government, this representation was false because at the time of the loan application, PPOA required its physicians to schedule an allegedly unnecessary evaluation and management appointments with patients every 14 days instead of monthly and to bill the evaluation and management appointments using high-level procedure codes in order to compensate for lost revenue resulting from Florida’s suspension of all non-emergency medical procedures in March 2020.  

In addition to paying $24.5 million, PPOA agreed to enter into a 5-year Corporate Integrity Agreement (CIA) with the Department of Health and Human Services Office of Inspector General (HHS-OIG), which requires PPOA to, among other things, maintain a compliance department, medical director and oversight board, retain a compliance expert, provide management certifications, maintain written standards, conduct training and education, obtain multiple annual claims reviews by an Independent Review Organization, establish a risk assessment and internal review process, and implement monitoring of testing referrals.

Read DOJ’s press release here and a copy of the settlement agreement here.

Skagit Family Health Clinic Agrees To Settle Fraud Allegations 

Skagit Family Health Clinic of Mount Vernon, Washington, agreed to pay $120,000 to state and federal governments to resolve allegations that it filed false claims with state and federal medical programs between 2015 and 2020. According to DOJ’s press release, the clinic unlawfully imported birth control medications that were not approved by the Food and Drug Administration from a foreign source and then submitted claims for these birth control medications to state and federal medical programs.  

Read DOJ’s press release here.

© 2023 ArentFox Schiff LLPNational Law Review, Volume XII, Number 105

About this Author

D. Jacques Smith Attorney Litigation ArentFox Schiff Washington DC
Partner and Complex Litigation Practice Co-Leader

Jacques focuses his practice on government investigations and enforcement. Recognized as one of the top False Claims Act practitioners in the country, his clients largely encompass all branches of health care and life sciences. He has more than 30 years of experience handling jury, bench, and administrative trials in a variety of civil and criminal cases in state and federal courts throughout the country. Jacques excels at handling complex commercial disputes and internal investigations and responding to government inquiries. 

Jacques is...

Randall A. Brater Litigation Attorney ArentFox Schiff Washington DC

Randy routinely litigates high-stakes matters in state and federal courts, including preliminary injunctions, motions practice, jury and bench trials, arbitrations, and mediation.

Randy often handles matters related to investigations and the False Claims Act, municipal bond finance, and trademark litigation. Randy also has represented agricultural chemical manufacturers in numerous data compensation disputes arising under the Federal Insecticide, Fungicide and Rodenticide Act (FIFRA), environmental actions under CERCLA, employment, trade secret...

Mohammed T. Farooqui ArentFoxSchiff

Mohammed has conducted internal and external investigations to assess compliance with federal and state laws, advised companies on adopting strategies to ensure compliance with anti-bribery and anti-corruption laws and regulations, and defended companies and individuals in actions brought by the DOJ and SEC. 

His experience includes leading a team of ArentFox Schiff attorneys tasked with reviewing the practices and procedures of one of the largest law enforcement agencies in the United States. Mohammed's regulatory enforcement experience...

Laura Zell Associate ArentFox Schiff LLP

Laura specializes in intellectual property litigation, with a focus on trademark, trade dress, and copyright infringement, and complex litigation, as well as white collar defense and internal and government investigations. Laura has served as the lead associate at trademark and white collar trials in federal court, providing her with significant experience in all phases of litigation, ranging from discovery, motions practice, and witness preparation to direct and cross-examinations and post-trial motions.  

Intellectual Property...