Dermatologist Agrees To Pay $6.6 Million To Settle Allegations Of Fraudulent Billing Practices

KNOXVILLE, Tenn. – Dermatologist, John Y. Chung, M.D., and his follow Pores and skin Most cancers & Beauty Dermatology Heart, P.C. (“SCCDC”), which operates 13 dermatology clinics in southeast Tennessee and north Georgia, have agreed to pay $6.6 million to resolve allegations that they violated the False Claims Act by knowingly submitting false claims to federal healthcare applications for Mohs Micrographic Surgical procedures and different dermatological procedures.

This settlement resolves allegations that Dr. Chung and SCCDC knowingly submitted false claims for cost to Medicare, Medicaid, and different authorities payors for Mohs procedures that have been billed as if each the surgical procedure and pathology parts of the procedures have been carried out by Dr. Chung, when in actual fact not less than one portion was usually carried out by different people. The settlement additional resolves allegations that SCCDC usually billed Medicare for a number of procedures, carried out on the identical affected person on the identical day, in a fashion that improperly circumvented Medicare’s “a number of process discount rule.” The alleged misconduct occurred from 2010 by means of 2020.

“Authorities healthcare applications set up billing guidelines and tips to safeguard tax-payer funds. Billions of {dollars} meant to cowl the prices of healthcare companies are misplaced yearly to fraud, waste, and abuse, and when suppliers disregard billing necessities, the monetary viability of public applications and the healthcare they supply are put in danger. The U.S. Legal professional’s Workplace will aggressively root out suppliers whose billing practices reap the benefits of public applications for their very own non-public achieve,” stated U.S. Legal professional Francis M. Hamilton III.

“When well being care suppliers submit improper claims to federal well being care applications, they waste beneficial taxpayer {dollars},” stated Particular Agent in Cost Tamala E. Miles of the Division of Well being and Human Providers Workplace of Inspector Normal (HHS-OIG). “Working with our legislation enforcement companions, our company will proceed to guard federal well being care applications from fraud, waste, and abuse to make sure they can be utilized for his or her meant functions.”

“Well being care fraud, a extreme downside that impacts each American, prices our nation billions annually, takes crucial sources out of our well being care system, and contributes to the rising price of well being care for everybody. The FBI, together with our federal, state, and native companions, will proceed to supply sources to analyze allegations of fraud in public applications and maintain violators to account,” stated FBI Particular Agent in Cost Joseph E. Carrico, Knoxville Subject Workplace.

“The VA OIG is devoted to making sure veterans obtain the standard well being care they deserve, and we are going to proceed to work to make sure that VA healthcare applications aren’t compromised by fraudulent billing practices,” stated Particular Agent in Cost Kim R. Lampkins with the Division of Veterans Affairs Workplace of Inspector Normal’s Mid-Atlantic Subject Workplace. “The VA OIG thanks the US Legal professional’s Workplace, and our legislation enforcement companions for his or her efforts on this investigation.”

“To guard the integrity of federal well being care applications and the sufferers they serve, it is vital that suppliers are compliant with billing guidelines and procedures,” stated TVA OIG Inspector Normal Ben Wagner. “The TVA OIG is dedicated to figuring out and investigating healthcare false claims that negatively impression the folks of the Tennessee Valley. The TVA-OIG will proceed to work tirelessly alongside our legislation enforcement companions to guard the reliability of federal healthcare applications, and stop fraud, waste, and abuse. The TVA OIG want to thank the US Legal professional’s Workplace Jap District of Tennessee for diligently pursing decision of this case and guaranteeing funds have been correctly returned to TVA.”

“Well being care suppliers that serve our nation’s navy service members, retirees and their households are anticipated to satisfy the best requirements of moral {and professional} conduct,” said Particular Agent in Cost Darrin Okay. Jones, DoD Workplace of Inspector Normal, Protection Legal Investigative Service (DCIS), Southeast Subject Workplace. “This settlement sends a transparent sign to those that reap the benefits of TRICARE for private enrichment.”

“Our Medicaid Fraud Division works every day to uphold the integrity of Georgia’s Medicaid program.,” stated Georgia Legal professional Normal Chris Carr. “This contains placing a cease to suppliers who submit false claims and reap the benefits of our publicly funded healthcare system. The sort of fraud and abuse is not going to be tolerated as we proceed our efforts to guard taxpayer {dollars} irrespective of the quantity.”

As a part of the settlement, Chung and SCCDC entered an Integrity Settlement (IA) with the U.S. Division of Well being and Human Providers – Workplace of Inspector Normal (HHS-OIG), which promotes its future compliance with the statutes, rules, program necessities, and written directives of Medicare and all different federal well being care applications. TheIA focuses on the follow’s persevering with obligation to precisely invoice and correctly submit reimbursement claims to authorities payors.

This investigation resulted from a coordinated effort between HHS-OIG (Nashville Subject Workplace), the Federal Bureau of Investigation (Knoxville), Tennessee Bureau of Investigation, Protection Legal Investigative Service, Tennessee Valley Authority – OIG, U.S. Division of Veterans Affairs – OIG, the U.S. Attorneys’ Workplace for the Jap District of Tennessee, the Tennessee Legal professional Normal’s Workplace, and the Georgia Legal professional Normal’s Workplace. The investigation was prompted by a lawsuit filed beneath the qui tam, or whistleblower, provisions of the False Claims Act, which allows non-public events to sue on behalf of the federal government for false claims, and to obtain a share of any restoration. The qui tam case is captioned United States, State of Tennessee and State of Georgia ex rel. Chambers v. Pores and skin Most cancers and Beauty Dermatology Ctr. and Chung, No. 1:20-CV-177 (E.D. Tenn.). The relator’s share of the restoration will probably be $1.32 million.

Assistant U.S. Attorneys Jeremy Dykes and Alexa Ortiz Hadley represented the US. Senior Assistant Legal professional Normal Tony Hullender represented the State of Tennessee, and Assistant Legal professional Normal Sara Vann represented the State of Georgia.

The claims settled by this settlement are allegations solely, and there was no dedication of legal responsibility.