ATHENS, Ga. -A $5,000,000 civil settlement has been reached with Mark A. Ellis, M.D., and his practice, Ellis Pain Center (EPC), a pain management practice in the Athens area. Part of the civil settlement includes EPC’s practice manager, Patsy Allen.
The case that was resolved by this settlement agreement-U.S. v. Mark A. Ellis, M.D., Patsy Allen, Mark A. Ellis, M.D., P.C., and Ellis Practice Management, LLC, 3:19-cv-107-was filed on Nov. 27, 2019. The settlement was finalized on Friday, March 17, 2023.
The defendants agreed to pay $5,000,000 to the United States to resolve allegations that they violated the False Claims Act (FCA) by submitting bills to the Medicare program for urine drug tests that were not performed, urine drug tests that were not medically necessary and for diagnostic tests that were not medically necessary for the treatment of its pain patients. The settlement resolves a civil investigation initiated by the Northern District of Georgia in the throes of the opioid epidemic. In 2015, the Middle District of Georgia joined the investigation and the two offices worked together to bring about today’s announced resolution.
“Together with our colleagues at the U.S. Attorney’s Office for the Northern District of Georgia, our attorneys have successfully concluded years of hard-fought litigation on behalf of the citizens," U.S. Attorney Peter Dr. Leary. “This office will continue to relentlessly pursue allegations of false billing for services not actually rendered to patients, particularly where opioids are involved."
“We will not allow health care providers to engage in schemes designed to enrich themselves and deplete the funds intended for the government’s federal health care programs," said Ryan K. Buchanan, U.S. Attorney for the Northern District of Georgia. “Our partnership with the U.S. Attorney’s Office for the Middle District of Georgia resulted in a just resolution on behalf of the Medicare Program and the taxpayers."
“Providers that bill Medicare for medically unnecessary procedures waste taxpayer dollars while drawing down on funds intended to support critical services for vulnerable patients," stated Tamala Miles, Special Agent in Charge with the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). “With our law enforcement partners, HHS-OIG is committed to investigating potentially fraudulent billing that can compromise the integrity of our federal health care programs."
The FCA is a federal law that imposes civil liability on any persons or entities who submit, or cause to be submitted, false claims for payment on the federal government or its contractors. The liability that can be imposed under the statute is treble damages (that is, three times the loss caused by the false claims) and a civil penalty between $12,537 to $25,076 per false claim. The FCA is the primary authority used by the United States Attorney’s Office’s Civil Division to redress fraud, waste, and abuse within federal programs, including, but not limited to, Medicare, Medicaid, and TRICARE.
The United States alleges that Dr. Ellis, Patsy Allen and EPC billed Medicare for individual and expensive quantitative urine drug tests that it did not actually conduct and, in fact, could not have conducted on its immunoassay analyzer. Additionally, Dr. Ellis, Ms. Allen and EPC allegedly billed Medicare for the same urine drug tests and diagnostic tests on its patients without regard to the patients’ individual signs, symptoms and medical needs and simply in a desire to increase EPC’s revenue.
The claims resolved by this settlement are allegations only, and there has been no determination or admission of liability.
This case was investigated by Special Agent Michael Britton and Investigator Shaketia Morgan of the U.S. Department of Health and Human Services-Office of the Inspector General (HHS OIG).
Assistant U.S. Attorneys Todd P. Swanson and Bowen Shoemaker of the Middle District of Georgia and Assistant U.S. Attorney Neeli Ben-David for the Northern District of Georgia represented the United States in civil action and settlement agreement.
Source: U.S. Department of Justice, Office of the United States Attorneys