The U.S. Department of Justice (DOJ) in a recent press release revealed details of a $1.36 million payment to settle Medicare and Medicaid fraud claims.

The payments were made by three San Antonio, Texas affiliates of Houston-based Christus Health. The DOJ announcement showed that the three defrauded both Medicare and Medicaid from 1997 through 2000.

The accord and payout settles charges against Primary CareNet of Texas (PCN) and Health Texas Medical Group (HTMG) both on its own behalf and as successor with interest in Solomon Anthony Clinic (SAC). They are alleged to have committed fraud against the programs by charging Medicaid and Medicare inappropriately for physicians’ management and evaluation services.

"This settlement again demonstrates the United States' commitment to protecting federal funds from fraud and abuse," said Robert D. McCallum, Assistant Attorney General in charge of the Civil Division.

A whistleblower lawsuit filed by PCN’s former CFO, Timothy Ohman, initiated the action which led to the government’s stepping in and prosecuting the case. Under the provisions of the False Claims Act, citizen whistleblowers may file suit on behalf of the US government.

Whistleblowers have played a large role in uncovering and reporting Medicaid fraud and other forms of abuse against government programs. Besides their responsible citizenship, these persons may also share in funds recovered by the lawsuits they initiate.

Ohman charged that HTMG and SAC, two medical practice groups, and PCN, a medical practice and management and billing company, illegally charged for evaluation and management services for Medicare and Medicaid patients.

HTMG and SAC, as a consequence, received higher payments from Medicare and Medicaid than they should have.

"Medicare and Medicaid fraud and abuse is a crime against the American taxpayer," stated Johnny Sutton, United States Attorney, Western District of Texas. “With vigorous enforcement actions such as these, we help to insure the future of the Medicare and Medicaid Trust Funds”.

Have information on Medicaid Fraud?

If you have information about Medicaid fraud, contact the Medicaid Fraud Reporting Center for a confidential claim evaluation today. You may report Medicaid fraud by completing the form on this page, or by calling our Medicaid Fraud Hotline at 1-800-934-2921.