- March 31, 2022
Physician Partners of America, founder Rodolfo Gari and former chief medical officer Abraham Rivera must pay $24.5 million to the U.S. Department of Justice for ordering unnecessary tests, making unlawful payments to doctors and lying on applications for COVID-19 relief funds, federal officials say.
The penalty settles allegations leveled against the Tampa pain management medical group, which has offices in Florida, Texas and California.
In addition to the $24.5 million, the medical group also entered a five-year Corporate Integrity Agreement with the U.S. Department of Health and Human Services' Office of Inspector General, according to a statement. The agreement requires PPOA, as the company is known, to “undertake significant compliance efforts” including maintaining a compliance department with a medical director and oversight board, hiring a compliance expert, creating a risk assessment and internal review process and monitoring testing referrals.
“Holding health care providers accountable for inflated claims and false statements helps ensure the integrity of the healthcare system as a whole,” Roger B. Handberg, U.S Attorney for the Middle District of Florida, says in the statement. “Settlements like this one are an important step in that direction.”
Gari, who founded PPOA in 2013, did not respond to a request for comment sent via LinkedIn.
The justice department accused PPOA of requiring it doctors to order urine tests for drugs and other tests whether they were necessary or not. The medical group’s toxicology lab would then bill federal health care programs for the tests at the highest available levels, officials contended.
To incentivize doctors to put in the orders, the medical group paid the physicians 40% of the profits from the tests, authorities allege. This, the justice department says, violates a federal law that prohibits doctors from referring patients to “‘designated health services’ payable to Medicare or Medicaid” when they or their immediate family has a financial relationship.
The medical group also required patients to go through genetic and psychological testing before seeing doctors whether the testing was needed or not. As it did with the other tests, PPOA would then bill federal health care programs.
In addition to the testing allegations, the justice department says the medical group forced doctors to schedule unneeded evaluations and appointments every 14 days to make up for revenue it lost when the state suspended non-emergency medical procedures during the early days of the pandemic. Doctors were then told to bill for these visits “using inappropriate high-level procedure codes,” the release states. Before the COVID-19 rules were in place, the practice scheduled these appointments at 30-day intervals.
As this was going on, PPOA was applying for a $5.9 million Paycheck Protection Program loan through the Small Business Administration. The justice department says to get the loan PPOA falsely claimed it wasn’t engaged in any unlawful activity.
“Billing federal health care programs for services that providers know are unnecessary or unreasonable undermines the quality of care that patients receive and increases the costs of these taxpayer-funded programs,” says Brian M. Boynton, principal deputy assistant attorney general and head of the justice department’s civil division.