(The Center Square) – The U.S. Department of Justice on behalf of the Department of Health and Human Services, along with the California Division of Medi-Cal Fraud and Elder Abuse, and the Oregon Medicaid Fraud Control Unit has reached a settlement with Dr. Francis Lagattuta proprietor of Lags Spine & Sportscare Medical Centers, Inc., to resolve allegations of “knowingly” submitting false claims to Medi-cal and Medicare from March 2016 through August 2021.
California Attorney General Rob Bonta commented, “Billing for services that providers know are unnecessary undermines the quality of care that patients receive, and increases the costs to the Medi-Cal program. I am grateful to the U.S. Attorney’s Office for their partnership in this effort to hold Dr. Lagattuta to account. My office remains committed to pursuing justice against those who seek to abuse the Medi-Cal system for their own benefit.”
Lags operated in the Central Valley and Central Coast of California and in Oregon, through Dr. Lagattuta’s pain management clinics, ambulatory surgical centers, and a physician-owned laboratory.
The allegations claim that Dr. Lagattuta provided many medically unnecessary procedures and billed the programs for reimbursement in violation of state and federal False Claims Acts..
Tuesday’s announcement of the $11,267,114.43 settlement, plus interest, reasonable expenses, attorneys’ fees, and costs, will disburse to California $2.7 million and to Oregon $130,000. The United States will receive around $8.5 million.
The agreement excludes Dr. Lagattuta from all Federal healthcare programs for a period of 5 years.
One of the violations uncovered in the four year investigation, conducted by the California Department of Justice’s Division of Medi-Cal Fraud and Elder Abuse (DMFEA), the United States Attorney’s Office for the Eastern District of California and the U.S. Department of Justice, found that Dr. Lagattuta through his large network of Lags Medical Clinics, systemically ordered skin biopsies,
As a matter of procedure, Dr. Lagattuta required every patient to have epidermal nerve fiber density testing performing “punch biopsies” of skin. He set quotas that “every provider does 2-3 ‘punch biopsies’ a day period” or 250 biopsies per week and told Lags Medical providers to resign if they refused to perform skin biopsies.
“Thousands of Medi-Cal patients trusted Dr. Lagattuta to take away their pain,” said Attorney General Rob Bonta. “Instead he exploited their trust by carrying out arrays of unnecessary tests and billing for them over the objections of the doctors he employed.”
Sixteen percent of all Lags Medical patients covered by Medicare, Medi-Cal, and Oregon Medicaid received multiple biopsies.
The case was brought by “whistleblower” Steven Capeder, a former director of marketing and operations at Lags.
