A Philadelphia mental health clinic and its psychiatrist owner have agreed to settle allegations of Medicaid fraud to the tune of $900,000, according to a recent announcement from the United States Attorney's Office. Dr. Ghodrat Pirooz Sholevar and his company, Nueva Vida Multicultural/Multilingual Behavioral Health, Inc., stand accused of bilking Medicaid by billing for medication management appointments that were not up to the mandated 15-minute duration.
These appointments, also known as 'med checks', are critical for the evaluation and adjustment of psychiatric medications. The government asserted that Nueva Vida was consistently submitting false bills for these visits, which were likely considerably shorter than the required period. The clinic was also accused of billing for more appointments than could feasibly be conducted in a standard workday, had each session lasted the full 15 minutes. The intention to defraud Medicaid appeared most brazen, as the clinic reportedly falsified documentation to create the impression that visits met the duration criterion.
According to the U.S. Attorney's Office, this case centers on activities occurring between January 15, 2009, and March 31, 2017, during which audits and notifications to the defendants did little to correct the fraudulent practices. An amended complaint filed on May 7, 2024, details how Sholevar falsely recorded patient start and end times, even alleging that he purported to see multiple patients during the same time slots at different locations.
"The defendants allegedly overbilled the Medicaid program at the expense of low-income Philadelphians, including children, who were seeking mental health services," U.S. Attorney Jacqueline C. Romero said. These individuals, the statement implies, may not have received the comprehensive care they were entitled to due to these shortened sessions. Nueva Vida and Sholevar, despite previous warnings, continued to render services that did not comply with the scheduling regulations—part of a deeper narrative of healthcare systems strained and sometimes snapped by the very humans entrusted to steward them.
The settlement resulted from efforts by the Department of Health and Human Services Office of Inspector General (HHS-OIG), with Special Agent in Charge Maureen R. Dixon, commenting, "The defendants’ actions defrauded the Medicaid program and may have resulted in patients not receiving the full services they deserve." The False Claims Act lawsuit settled by this agreement serves as a stark reminder of the government's ongoing battle against healthcare fraud.
Assistant United States Attorneys Erin Lindgren and Gregory in den Berken, along with auditor George Niedzwicki, spearheaded the investigation and settlement for the U.S. Attorney’s Office. While the settlement closes this chapter by resolving the lawsuit, it's important to note the claims dealt with by the settlement are allegations; no liability determination has been made as part of the agreement.
