Michigan post-hospitalist firm sued, accused of $40M in Medicare fraud

The Justice Department is suing Novi, Mich.-based General Medicine, its owner and 17 related companies, alleging a widespread healthcare fraud scheme involving the submission of thousands of false claims to the Medicare program.

General Medicine and the other companies owned by Thomas Prose, MD, employed physicians and nurse practitioners to treat patients in nursing homes and assisted living facilities in several states, including Illinois and Missouri, according to an April 1 U.S. Justice Department news release. 

The Justice Department alleges the defendants knowingly billed Medicare for visits with facility residents that were not medically necessary, did not meet billing code requirements, or were not performed at all. 

General Medicine allegedly directed their physicians and nurse practitioners to meet visit quotas and make numerous patient visits and assessments each month without any consideration of whether patients needed the services. 

The defendants also submitted inflated claims to Medicare when providers spent only the minimal amount of time with patients, according to the allegations. 

Medicare has paid the defendants $40 million since 2016, according to the news release.

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