Ringgold-based nonprofit corporation and healthcare provider North Georgia Healthcare Center Inc. and its CEO, Delaine Hunter, have agreed to pay $130,000 to settle allegations that they violated the False Claims Act.
It was alleged that, between Jan. 1, 2012 and Sept. 10, 2018, the firm caused the submission of medically unnecessary claims for Schedule II controlled substances to the United States and the state of Georgia.
Specifically, the complaint alleges that Dr. Gary Smith, a former physician at North Georgia Healthcare Center, improperly prescribed opioids without appropriate medical review and judgement of medical necessity.
"Medical professionals are trusted to prescribe controlled substances in compliance with the law and in a manner that protects the health and safety of their patients," said Acting U.S. Attorney Kurt R. Erskine. "We will continue to vigorously pursue those who breach that trust using every tool at our disposal."
Under Georgia law, only physicians, not mid-level practitioners such as physician assistants, can write prescriptions for Schedule II drugs, which include, but are not limited to, opioids such as oxycodone and hydrocodone. Whenever a physician assistant interacts with a patient and concludes that they require a Schedule II drug, a supervising doctor must concur that the pertinent drug is medically necessary and must sign off on the associated prescription at that time.
To be reimbursable under government insurance programs such as Medicare, Medicaid and Tricare, drugs prescribed by a physician must be rendered pursuant to the prescriber's medical judgment, and reasonable and medically necessary.
The government alleges that physician assistants - and not Dr. Smith - saw a majority of the patients at the health care center. Smith only visited North Georgia Healthcare Center one afternoon per week, and rarely saw patients or reviewed their charts. The government further alleges that Smith routinely signed stacks of prescriptions for patients that he had neither seen nor otherwise evaluated, including but not limited to prescriptions for Schedule II drugs. It is also alleged that the center's CEO failed to promptly address this behavior once alerted to it by several employees.
In a separate settlement agreement with the United States Department of Health and Human Services' Office of Inspector General, Smith has agreed to a voluntary 10-year exclusion from participation in all federal health care programs. As a result, both Smith and any provider using Smith's services will be unable to obtain reimbursement for care provided to any patients insured under a government health care program, such as Medicare, Medicaid and Tricare.
The settlement resolves a lawsuit filed in the U.S. District Court for the Northern District of Georgia by a former North Georgia Healthcare Center employee under the whistleblower provisions of the False Claims Act, which permits private citizens to bring lawsuits on behalf of the United States and obtain a portion of the government's recovery. The claims resolved by this settlement are allegations only and there has been no determination of liability.
"Healthcare fraud is not a victimless crime, with fraudsters often preying on beneficiaries across the country," said Special Agent in Charge Derrick L. Jackson with the Department of Health and Human Services Office of Inspector General. "Especially insidious is the fraud committed by health care practitioners who are trusted to prescribe only medically necessary, quality services to patients. Working closely with our law enforcement partners, our agency will continue to protect the public by holding those responsible for such schemes responsible for their actions."
News of the $130,000 settlement comes just after state data revealed a sharp increase in the number of opioid-related deaths in Georgia's Northwest region, which includes the city of Ringgold and Catoosa County, as well as Bartow, Chattooga, Dade, Floyd, Gordon, Haralson, Paulding, Polk and Walker counties, over the last year.
(Read more: Opioid-related deaths increased 45% in Northwest Georgia)
Georgia Attorney General Chris Carr said allegations similar to those outlined in the North Georgia Healthcare Center settlement will receive his full attention because of the potential harm to Georgians and the "improper use of taxpayer dollars."
"We are fighting the opioid epidemic on many fronts, including holding those accountable who improperly prescribe without appropriate medical review and judgement," Carr said.
When asked about the settlement, North Georgia Healthcare Center, Inc. CEO Delaine Hunter said neither she nor the company tolerate or approve of the type of behavior outlined in the allegations. She said "swift action" was taken to terminate Smith when she was made aware of the situation and noted that he no longer has a relationship with the center.
"When this situation came to light, swift action was taken to terminate the employee and make sure there was no additional access or continued relationship with the facility," Hunter said. "Our first and highest priority is the care of our patients and we do not tolerate this type of behavior."
Hunter is well-known for her involvement in the health care industry, particularly in Northwest Georgia, where she and associates are planning to build a 374-acre, $150 million health care facility in Walker County next year. The facility is set to offer health care, counseling, housing for up to 1,200 people, and work opportunities for veterans, children and families, as well as an outdoor sports and recreation pavilion.
(Read more: Healthy Foundation gets backing for Walker County campus)
Contact Kelcey Caulder at kcaulder@timesfreepress.com.