Los Angeles, California — Two doctors, the prior owners of the now defunct West Alabama Emergency Physicians, P.C. (WAEP) located in Northport, Alabama, will pay $1.3 million in a Medicare fraud settlement over a whistleblower lawsuit claiming they collectively defrauded the government by submitting false claims to Medicare, Medicaid, and TRICARE. The Relator (whistleblower), Ahmed Mahmoud Moussa, M.D., will receive a reward of $234,000 for his role in bringing the fraud allegations to the government’s attention. Dr. Moussa was represented by whistleblower attorneys Mark H. Schlein and Diane Marger Moore of Baum Hedlund Aristei & Goldman.
According to the qui tam lawsuit, WAEP, along with owners John Newcomb, M.D., and Jimmy Tu, M.D., provided contract services to DCH Healthcare System, and in particular to Northport Medical Center for emergency department physician and nurse-practitioner staffing.
Northport is in “an underserved” population area where there is a shortage of physicians and other healthcare providers, the complaint says. A significant percentage of DCH patients are enrolled in Medicaid, Medicare, and other government healthcare programs.
Dr. Moussa was hired by WAEP in November of 2011. When he was being oriented to the emergency department by WAEP president Dr. Tu, the Relator claims to have observed a nurse-practitioner providing patient care throughout the shift without consulting at all with the on-duty physician. Based on his experience at other hospitals supervising and directing nurse-practitioners, the Relator believed this was a violation of government healthcare rules.
According to allegations in the complaint, when he questioned Dr. Tu about this, he was told that nurse-practitioners at Northport “work completely independently” from the Doctor. The Relator was also told that he would not have any face to face encounters with emergency room patients who were treated by nurse-practitioners. Despite never actually seeing the patient, the complaint alleges that all charts for emergency room patients were signed off on by the physician on that shift.
The Relator learned that these nurse-practitioners did not have NPI (national provider identification) numbers, the qui tam lawsuit claims and that they charted and billed for their services under the NPI of the physician on duty during their shift. According to the complaint, this meant that patient services provided by nurse-practitioners were billed at the doctor’s higher rate even though the physician never saw the patient. Newcomb and Tu allegedly created the now bankrupt Nouveau Solutions as a billing entity to submit their alleged false and fraudulent statements and records to government healthcare programs. The complaint alleges that this billing scheme existed between July 1, 2007, and December 31, 2013.
“Dr. Moussa was concerned that the billing practices alleged in the complaint not only violated Medicare and Medicaid rules but potentially deprived patients of the level of care they should have received,” said whistleblower attorney Mark Schlein. “By having the courage to step forward, the improper practice was stopped. The Relator and other courageous whistleblowers like him are frontline soldiers in the war against health care fraud.”
The case is captioned United States ex rel. Ahmed Mahmoud Moussa, MD., Plaintiff and Relator, v. The DCH Healthcare Authority, Inc.; Northport Medical Center; West Alabama Emergency Physicians, P.C.; Jimmy Tu, MD.; John Newcomb, MD.; and Nouveau Solutions, LLC, Defendants, Civil Action No. CV-13-B-1538-W.
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