Medical company bilked Medicare of millions, southern Illinois lawsuit alleges
The U.S. Department of Justice is alleging Medicare fraud against a Michigan-based medical company and its owner in a lawsuit filed in the District Court of Southern Illinois Friday.
The suit names Dr. Thomas M. Prose, his business, General Medicine PC and 17 related corporate entities.
A 96-page complaint alleges that General Medicine violated the False Claims Act in a widespread healthcare fraud scheme, by submitting thousands of false claims to the Medicare program. The Medicare payments since 2016 total more than $40 million, the suit alleges.
General Medicine and the other entities owned by Prose are based in Novi, Michigan
According to the complaint, the company hired physicians and nurse practitioners to treat patients in nursing homes and assisted living facilities in numerous states, including Illinois and Missouri.
The government complaint alleges General Medicine knowingly billed Medicare for services to facility residents that weren’t medically necessary, did not meet the requirements of the billing codes, or were not performed at all.
It also alleges that General Medicine directed its doctors and nurse practitioners to meet visit quotas and perform numerous patient visits and assessments each month without any consideration as to whether the patients needed the services.
The complaint also alleged the General Medicine submitted inflated claims to Medicare using billing codes that indicated complex, comprehensive visits, when the healthcare providers spent only minimal time with patients.
General Medicine, on multiple occasions, submitted completed progress notes containing inaccurate information or embellished portions of the note to bill the visits using codes with higher reimbursement rates, the complaint states.
“Vulnerable patients living in nursing homes and assisted living facilities should receive their medical needs and no needless visits manufactured to meet artificial corporate quotas,” said U.S. Attorney Steven Weinhoeft. “Billing Medicare for unnecessary and worthless services at inflated rates drains valuable taxpayer funding from the program and ultimately harms the patients who need it most.
“We will continue to work closely with our law enforcement partners to ensure federally funded healthcare programs are not abused.”
An investigation of Prose and General Medicine was conducted collaboratively by the U.S. Attorney’s office in the Southern District of Illinois, the U.S. Department of Health and Human Service, Office of Inspector General, Illinois State Police Medicaid Fraud Control Unit, the FBI, the and the Department of Defense, Office of the Inspector General U.S. Department of Labor, Employee Benefits Administration, the .S. Postal Inspection Service