Vohra Wound Physicians Management and its owner, Ameet Vohra, MD, have agreed to pay $45 million to resolve allegations that they knowingly submitted false claims to Medicare.
- What happened?
The Justice Department alleged that Dr. Vohra and his companies submitted false claims to Medicare for medically unnecessary surgical procedures, for more lucrative procedures when only routine non-surgical wound management had been done, and for evaluation and management services that were not billable under Medicare coverage and coding rules, according to a Nov. 21 news release. - Vohra Wound Physicians Management is one of the country’s largest providers of bedside specialty wound care for nursing homes and skilled nursing facilities. In April, the Justice Department filed a lawsuit alleging the company engaged in a nationwide fraudulent billing scheme. The lawsuit alleged that the company pressured, trained and provided financial incentives for its physicians to perform debridement procedures during as many patient visits as possible regardless of the patients’ needs.
- The Justice Department said that it did not matter what kind of debridement a physician performed because the company allegedly programmed its EHR and billing software to ensure that Medicare was always billed for the higher-reimbursed surgical excisional procedure and to create false medical record documentation to support the scheme.
- Dr. Vohra allegedly orchestrated the scheme, which was implemented by his senior management team.
- Under the agreement, the company will enter into a five-year corporate integrity agreement with the HHS Office of Inspector General. The company must develop and maintain a compliance program, implement a risk assessment process and hire an independent review organization to review its claims and health information technology systems.
- Vohra Wound Physicians said in a statement that it determined reaching a settlement was the “most responsible choice to ensure financial stability and to safeguard uninterrupted care for its patients.” The settlement is includes no admission of liability by the defendants, “who continue to firmly deny the allegations.”
