The U.S. government has brought a lawsuit under the False Claims Act against Vohra Wound Physicians Management LLC, one of the nation's leading providers of specialty wound care services, and its owner, Dr. Ameet Vohra, for allegedly submitting forged claims to Medicare. According to the Justice Department, the complaint accuses the defendants of causing false claims to be made for overbilled and medically unnecessary services across the hundreds of nursing homes and skilled nursing facilities they serve.
In a detailed accounting of the allegations, the complaint lodged with the U.S. District Court for the Southern District of Florida maintains that the defendants knowingly put in place a nationwide scheme to bill Medicare for surgical debridement procedures that were either not completed or not medically necessary. Debridement is a medical procedure intended to expedite healing by removing dead or infected tissue from a wound. The defendants, according to the Justice Department, accomplished this through several strategies including the use of proprietary Electronic Medical Record (EMR) software designed to automatically bill these procedures as surgical interventions.
The company's employment and training practices also came under fire. Vohra allegedly hired physicians without the necessary expertise in wound care and provided them with training that purposefully overlooked relevant Medicare payment rules. Further, the complaint suggests that Vohra Wound Physicians Management, spurred by a hunger for increased revenue, imposed corporate targets on debridement that were grounded not in medical need, but purely in financial aspiration.
Another significant part of the case against Vohra involves the alleged misuse of billing code 'Modifier 25', which is meant to note a significant, separately identifiable medical service on the same day as a procedure is performed. The suit alleges the Vohra’s EMR was programmed to tack on Modifier 25 indiscriminately, leading to claims for examinations that should not have been billed separately from the debridement service. “Healthcare fraud is harmful to all consumers, artificially and unnecessarily increasing the costs of care for everyone,” said Acting U.S. Attorney Tara M. Lyons for the Southern District of Georgia, a sentiment echoed through the legal actions being pursued by several judicial branches, according to the Justice Department.
This legal maneuver signifies a broader federal effort to tackle fraud within the healthcare system. As the pursuit of justice unfolds, it should be noted that the claims put forth in the government’s case remain allegations; no definitive judgment of liability has yet been made. The matter is being overseen by notables such as Trial Attorney Kirsten Mayer of the Civil Division's Fraud Section and Assistants U.S. Attorney Ryan Grover for the Southern District of Georgia and Christopher Cheek for the Southern District of Florida, all intent on applying the rigorous standards of the False Claims Act in this ongoing inquiry.
