A Memphis nephrologist has agreed to pay $375,296.90 to settle allegations of fraudulently billing Medicare for end-stage renal disease (ESRD) treatments that were not actually provided, as announced today by U.S. Attorney for the Western District of Tennessee, D. Michael Dunavant. The nephrologist, Dr. Mark Shermer, was implicated in a scheme involving billing for dialysis patient visits that never took place, according to a report from the U.S. Attorney's Office.
In a case that highlights the ongoing battle against health care fraud, which inflates costs and jeopardizes services meant for the truly ill, U.S. Attorney D. Michael Dunavant expressed that "Falsely billing Medicare for dialysis procedures that never occurred contributes to the soaring costs of health care and ultimately harms actual patients," the consequences of such actions reiterate the critical need for vigilance in the health care system; an especially poignant note given the backdrop of an overburdened health care infrastructure still reeling from the impacts of a global pandemic, while the whistleblower, or qui tam, provisions of the False Claims Act encourage individuals to expose fraudulent acts by allowing them to file actions on behalf of the United States and potentially share in the monetary recoveries of such cases, as stated by the U.S. Attorney's Office.
This settlement does not constitute an admission of guilt, as the claims resolved by this agreement are allegations only. The case was brought under the qui tam provisions of the False Claims Act, which allows private citizens to sue on behalf of the government and share in any recovered funds, the whistleblower in this case stands potentially to receive a portion of the settlement as a reward for their role in bringing the alleged fraud to light, as reported by the U.S. Attorney's Office.
The investigation was a collaborative effort between the Department of Health and Human Services Office of Inspector General and the Tennessee Bureau of Investigation, with Special Agent in Charge Kelly Blackmon stating, "Providers who submit false claims to Medicare compromise the integrity of federal health care programs and the services they are meant to provide," stressing the cooperation between law enforcement agencies as being crucial to the protection of taxpayer dollars and the integrity of federal health care programs, as stated by the U.S. Attorney's Office.
Assistant United States Attorney Sarah Pazar Williams represented the United States in bringing this case to resolution, indicating the government's continued commitment to upholding the law in the realm of healthcare finances. The case, outlined as United States ex rel. Davis, 2:21-cv-2754-JTF-cgc (W.D. Tenn.), points to the larger issue of ethical medical practices and the ways in which the judicial system aims to keep practitioners accountable, as per the U.S. Attorney's Office.
