The settlement amount represents twice the amount of compensation received by Dr. Deshpande and Pinnacle Health Care for the alleged improper billing.
The settlement agreement between the United States Department of Justice, the State of Washington, Dr. Deshpande and Pinnacle Health Care secured the United States agreement to abstain from filing an affirmative civil enforcement lawsuit against the doctor and his company under the False Claims Act, Title 31 United States Code, Sections 3729 -3733 on the grounds of alleged fraudulent and false Medicare and Medicaid billings.
Under the False Claims Act, parties who submit false claims to the Medicare and Medicaid programs can be held liable for triple the amount paid to the party through the false claim and subjected to civil penalties of $5,500 to $11,000 for each false claim submitted to the government.
By accepting responsibility for their billing errors, Dr. Deshpande and Pinnacle avoided these potentially harsh penalties and worked with the United States and the State of Washington to obtain a mutually agreeable resolution to the claims.
As stipulated in the settlement agreement, the United States and the State of Washington alleged that from January 1, 2009, to November 30, 2009, Dr. Deshpande and/or Pinnacle Health Care submitted claims for nerve conduction studies, needle electromyography testing, and h-reflex testing when the services were not provided by a licensed physician; and that from January 1, 2009, through August 31, 2011, Dr. Deshpande and/or Pinnacle Health Care submitted claims for both the professional and technical component for polysomnographic testing when Dr. Deshpande and/or Pinnacle Health Care performed the technical component of the test, but the professional component was completed and billed for by a physician not associated with Dr. Deshpande and/or Pinnacle Health Care; the professional component of the testing was not provided in the United States; and/or the claims were duplicative (double-billing).
United States Attorney Michael C. Ormsby said: "Fraud against programs that fund health care in our community will not be tolerated and will not pay off for those who don't follow the rules. This matter is a superb example of the successful outcomes made possible by the collaborative efforts of our state and federal partners to investigate, combat, and resolve health care fraud."
"When providers commit Medicaid and Medicare fraud, less money is available for health care," said Attorney General Bob Ferguson. "Our Medicaid Fraud Control Unit collaborated with state and federal partners to crack down on fraud and recover funds for taxpayers."
The combined efforts of the United States Departments of Justice and Health and Human Services' in health care fraud prevention and enforcement have recovered $14.9 billion since January 2009 in cases involving fraud against federal health care programs.
The settlement with Dr. Deshpande and Pinnacle Health Care was the result of a coordinated effort among the United States Attorney's Office for the Eastern District of Washington, the United States Department of Health and Human Services Office of Inspector General and Office of Counsel to the Inspector General, the State of Washington Attorney General's Medicaid Fraud Control Unit, and the State of Washington Health Care Authority.
This matter was handled by K. Jill Bolton, an Assistant United States Attorney, and Marty Raap, an Assistant Attorney General with Medicaid Fraud Control Unit.