$1.25M settlement reached with SC family practice clinics for billing unnecessary services

South Carolina News

COLUMBIA, S.C. (WCBD) – A $1.25 million settlement has been reached with family practice clinics in South Carolina for billing unnecessary services to federal health programs.

According to acting U.S. Attorney for the District of South Carolina, M. Rhett DeHart, Colonial Family Practice, LLC, filed claims for medically unnecessary nuclear stress tests ordered by two doctors with the organization between February 22, 2012, and November 26, 2019.

Colonial Family Practice is a physician-owned primary and urgent care practice with multiple clinics across South Carolina.

DeHart said, “The United States alleged the practice systematically billed for unnecessary Cystatin-C laboratory tests—a test to detect kidney dysfunction that is only payable in a narrow set of patients.”

Colonial Family Practice allegedly added this test to a panel run on most of its patients between August 13, 2013, and November 29, 2019.

Two whistleblower lawsuits led to the investigation. “One by a Physician Assistant formerly employed by Colonial and the other by a former clinical manager at the practice,” DeHart’s office said.

“False and inappropriate healthcare billing erodes public confidence in the healthcare system, subjects patients to unnecessary tests and procedures, and increases the cost of healthcare for active duty service members, retirees, and their families,” said Special Agent in Charge Christopher Dillard, Department of Defense Office of Inspector General, Defense Criminal Investigative Service (DCIS), Mid-Atlantic Field Office.  “DCIS and its law enforcement partners will continue targeting fraud waste and abuse of the TRICARE program and hold wrongdoers accountable.”

As part of the settlement, Colonial Family Practice agreed to a $1.25 million settlement to resolve allegations that it violated the False Claims Act by billing Medicare, Medicaid, and TRICARE for medically unnecessary services.

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