MOBILE, Ala. (CN) - A group of Alabama healthcare providers defrauded Medicaid and other governmental programs for more than $1 million by filing false medical claims, a federal attorney claims in court.
The complaint, filed in federal court, accuses James Crumb M.D., Coastal Neurological Institute PC and Mobility Metabolism and Wellness PC of violating the False Claims Act.
U.S. Attorney Kenyen Brown filed the case on behalf of the Department of Health and Human Services, CMS - which administers the Medicare and Alabama Medicaid programs - and the Department of Defense.
"Defendants knowingly submitted, or caused to be submitted, thousands of false claims, statements or records," the complaint, filed on Dec. 29, states.
As a result, the defendants allegedly "received over a million dollars in reimbursements to which they are not entitled."
The programs allegedly being exploited included Medicare, the Alabama Medicaid Agency and the TRICARE/CHAMPUS Program. The Department of Defense administers the TRICARE program, previously known as CHAMPUS, which includes a triple benefit plan for active duty and retired service members and their dependents.
The complaint claims the defendants used "false diagnoses of neurological disorders such as Spasmodic Torticollis" and Genetic Torsion Dystonia (GTD) to create a false, payable claim for Botox.
The Botox procedures, the complaint claims, were "not reasonable, not medically necessary and not supported by the medical charts."
The complaint claims the defendants made other misrepresentations such as billing for repeat procedures "when repeat procedures were not provided" and "over-ordering Botox medication that was not reasonable or medically necessary."
Crumb, the complaint alleges, specifically "assigned a diagnosis of ST and/or GTD, which are considered complex neurological and movement disorders, to over a thousand of patients in the Mobile, Alabama area over a relatively short time period."
The beneficiaries of those treatments, the complaint states, "were not aware that they had been diagnosed with a rare debilitating neurological disorder."
The government claims the defendants' fraudulent activities date back to at least 2007.
The plaintiff is seeking treble damages and civil penalties in the matter under the False Claims Act, monetary relief under the theories of unjust enrichment and payment under mistake of fact and punitive damages for unjust enrichment.
The defendants are all based in Mobile, Ala.
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