JACKSONVILLE, Fla. – The Department of Justice announced Wednesday that Southeast Orthopedic Specialists, a Jacksonville, Florida-based orthopedic medical group, has agreed to pay the government $4.488 million to resolve allegations that it violated the False Claims Act.
The United States contends that it has certain civil claims against Southeast Orthopedic Specialists (SOS) arising from the medical group billing federal health care programs for services that were not medically necessary and reasonable.
Specifically, that SOS sought reimbursement for millions of dollars' of health care claims that were questionable, according to the DOJ.
The United States alleges that these questionable bills include:
“The United States Attorney’s Office is committed to taking the steps necessary to protect Medicare and other federal health care programs from fraud,” said U.S. Attorney A. Lee Bentley. “When health care practitioners submit fraudulent claims for reimbursement, we will hold them accountable.”
Since January 2009, the Justice Department has recovered a total of more than $31.6 billion through False Claims Act cases, with more than $19.2 billion of that amount recovered in cases involving fraud against federal health care programs.
“The Department of Health and Human Services, Office of Inspector General will relentlessly seek out those who defraud the Medicare program,” said Special Agent in Charge Shimon Richmond. “Obtaining tax dollars which Medicare providers are not entitled to impacts our entire healthcare system and the OIG will hold health care providers accountable who misrepresent services to boost profits.”
This matter was investigated by the U.S. Department of Health and Human Services. The claims resolved by this settlement are allegations only, and there has been no determination of liability.