The United States Attorney’s Office for the Eastern District of Missouri announced today that a civil settlement has been reached to resolve allegations against Dr. Nehal Modh and his company, Progressive Pain Management (PPM), regarding false claims submitted to Medicare and Missouri Medicaid.
Dr. Modh, the president and sole owner of PPM in Festus, Missouri, was accused of falsely indicating the use of ultrasound guidance on certain pain management injections, submitting false claims for facet joint injections that did not meet billing substantiation requirements, and improperly coding claims to receive excess reimbursement.
As part of the settlement, Dr. Modh and PPM will repay $1.2 million to the United States, which includes $600,000 in restitution doubled under the False Claims Act (FCA).
The allegations were brought under the qui tam or whistleblower provisions of the FCA by Donna Chronister, a former employee of PPM. Under these provisions, a private party can file an action on behalf of the United States and receive a portion of the recovery. The case is captioned United States ex rel. Donna Chronister v. Progressive Pain Management, P.C., et al., case no. 4:19-cv-2245 in U.S. District Court in St. Louis. Chronister will receive $177,707 from the settlement proceeds.
“We thank the whistleblower for her courage to bring her concerns forward,” said U.S. Attorney Sayler A. Fleming for the Eastern District of Missouri. “This settlement is an example of our important civil enforcement efforts where we work with whistleblowers to protect the public fisc.”
“Health care fraud is a serious problem that costs taxpayers millions in wasted dollars while often depriving vulnerable beneficiaries of the care and support they need,” said Special Agent in Charge Linda T. Hanley from the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). “We will continue to aggressively investigate these cases in an effort to eliminate corruption in our health care system.”
This civil settlement resulted from combined efforts by the U.S. Attorney’s Office for the Eastern District of Missouri, HHS-OIG’s Office of Investigations and Office of Audit, the Missouri Attorney General’s Medicaid Fraud Control Unit, and the FBI.
