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Doctor settles health insurance fraud charge for $1.2M, whistleblower gets $177K

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(The Center Square) – A settlement reached with a Missouri doctor and his pain management practice will require a $1.2 million repayment to the federal government.

Dr. Nehal Modh and his company, Progressive Pain Management in Festus, Mo., reached an agreement with the U.S. Attorney for the Eastern District of Missouri to resolve allegations of knowingly submitting false claims to Medicare and Missouri Medicaid.

Modh, the sole owner of the business, falsely indicated ultrasound guidance was used on certain pain management injections to both government health insurance agencies, according to information from the U.S. Attorney. False claims also were submitted for injections into joints that didn’t meet billing substantiation requirements. Claims also were improperly coded to receive excess reimbursement.

“Health care fraud is a serious problem that costs taxpayers millions in wasted dollars while often depriving vulnerable beneficiaries of the care and support they need,” Linda T. Hanley, a special agent from the U.S. Department of Health and Human Services Office of Inspector General, said in a statement. “We will continue to aggressively investigate these cases in an effort to eliminate the corruption in our health care system.”

The False Claims Act requires the original restitution of $600,000 to be paid by Modh and his company to the federal government to be doubled. The False Claims Act also provides for compensation to be paid to a whistleblower if the person files a legal action on behalf of the U.S.

Donna Chronister, a former employee in Modh’s practice, will receive $177,707 from the proceeds of the settlement for filing a lawsuit with the United States against the business.

“We thank the whistleblower for her courage to bring her concerns forward,” Sayler Fleming, U.S. Attorney for the Eastern District of Missouri, said in a statement. “This settlement is an example of our important civil enforcement efforts where we work with whistleblowers to protect the public.”

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