US sues surgeon over alleged 1,000+ fraudulent claims

The U.S. sued a plastic surgeon formerly of Tri-State Specialists in Sioux City, Iowa, for violating the False Claims Act.

The complaint, filed May 9, alleges Dr. Smith submitted or caused the submission of false claims to Medicare and other government payers from August 2014 to August 2019. Dr. Smith is accused of billing for services he claimed were medically necessary but were actually medically unnecessary cosmetic procedures; upcoding and billing for surgeries he didn't perform; and overstating the complexity of office visits.

The U.S. is entitled to three times the cost of false claims submitted and per-claim penalties between $13,508 and $27,018. Dr. Smith allegedly was responsible for more than one thousand false claims submissions.

Tri-State Specialists agreed to pay a $612,501.44 settlement in December 2021.

The civil case was brought by a whistleblower, who stands to share in any funds recovered by the U.S.

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