Atlanta Pain Clinic and its owner agree to pay $250,000 to resolve allegations that they violated the False Claims Act
ATLANTA – Atlanta Medical Clinic (“AMC”), which is an Atlanta-based pain clinic, and Dr. Timothy Dembowski (AMC’s owner), have agreed to pay the United States $250,000 to resolve allegations that they violated Medicare rules and the False Claims Act (“FCA”) by billing the Government for: (1) services performed by a physician suspended from the Medicare program, and (2) the administration of foreign, non-FDA approved drugs, which are not eligible for reimbursement under the Medicare program.
“To maximize their profits, AMC and Dr. Dembowski violated Medicare program rules, and then exacerbated their misconduct by submitting false claims to the Government,” said U.S. Attorney John Horn. “Pursuing this investigation and securing this settlement highlights our continued diligence in combating waste, fraud and abuse with respect to federal health care programs.”
“This monetary resolution to allegations that violate the False Claims Act hopefully sends a message to health care providers that we are determined to root out any attempt to take advantage of our federal health care programs,” said David LeValley, Special Agent in Charge of the FBI’s Atlanta Field Office. “Healthcare providers like Dr. Dembowski and AMC need to think twice before they so willfully, and illegally try to maximize their profits.”
“When physicians and health care companies provide patients with drugs not approved by the FDA and bill for services provided by those suspended from the Medicare program, they violate the basic trust that is extended to healthcare professionals,” said Special Agent in Charge Derrick L. Jackson of the HHS-OIG’s Atlanta Region. “Our agents continue to work with the Department of Justice to root out such fraud schemes, which undermine the public’s confidence in, and the financial well-being of, federal health care programs.”
A joint investigation conducted by the U.S. Attorney’s Office for the Northern District of Georgia, the U.S. Department of Health and Human Services – Office of the Inspector General, and the Federal Bureau of Investigation revealed evidence suggesting that AMC and Dr. Dembowski violated the FCA through two separate schemes involving the submission of fraudulent Medicare claims to the Government.
First, AMC and Dr. Dembowski claimed and received payment for medical services rendered by a physician that worked at AMC (“Physician 1”). However, these claims were fraudulent as Physician 1 previously was suspended from the Medicare program in June 2013 for making false statements and omissions regarding his criminal history. Due to his suspension, no services rendered by Physician 1 were eligible for Medicare reimbursement. Both AMC and Dr. Dembowski were aware of Physician 1’s suspension, and that he was thus ineligible to provide services to Medicare patients.
Nevertheless, AMC and Dr. Dembowski circumvented Physician 1’s Medicare suspension and received Medicare reimbursements for Physician 1’s services, by falsely and fraudulently describing – in claims submitted to the Government – services that had been performed by Physician 1 as services performed by a different AMC physician (“Physician 2”) that was authorized to participate in the Medicare program.
Second, AMC and Dr. Dembowski violated the FCA by: (1) obtaining a foreign, non-FDA approved knee treatment drug – i.e, Orthovisc– from a firm in Canada; (2) utilizing such drug on Medicare patients; and then (3) seeking and receiving reimbursement from Medicare.
However, Medicare does not cover the costs of foreign, non-FDA approved drugs, and AMC and Dr. Dembowski never informed Medicare that the invoices involved the administration of foreign, non-FDA approved drugs.
The claims asserted against AMC and Dr. Dembowski are allegations only, and there has been no determination of liability.
This matter was handled by Assistant U.S. Attorney Paris A. Wynn.
For further information please contact the U.S. Attorney’s Public Affairs Office at USAGAN.PressEmails@usdoj.gov(link sends e-mail) or (404) 581-6016. The Internet address for the home page for the U.S. Attorney’s Office for the Northern District of Georgia Atlanta Division is http://www.justice.gov/usao-ndga.
|Written by Susen Sawatzki
Healthcare Industry Expert
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