Physician whistleblowers collect portion of $24M PPOA false claims settlement

Tampa, Fla.-based Physician Partners of America, its founder Rodolfo Gari, and its former chief medical officer Abraham Rivera, MD, will pay $24.5 million to settle allegations of violating the False Claims Act, the Justice Department said April 12.

The Justice Department said the settlement resolves claims brought under the whistleblower provisions of the False Claims Act by five current or former PPOA employees, three of whom are physicians. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery.

Physician Partners of America is alleged to have billed federal healthcare programs for unnecessary medical testing and services, illegally paying physician employees 40 percent of the profits from the unnecessary services and making a false statement in connection with a $5.9 million Paycheck Protection Program loan, the department said.

PPOA allegedly required physician employees to order multiple drug tests at the same time without determining whether they were needed and without reviewing initial testing to determine if further tests were needed, the department said. PPOA's affiliated toxicology lab then allegedly billed federal programs for the highest-level drug tests.

The Justice Department alleged that PPOA required patients to have, and billed federal programs for, genetic and psychological testing without any determination on whether they were necessary.

When Florida suspended nonemergency medical procedures in March 2020, PPOA allegedly required its physicians to schedule unnecessary evaluation and management appointments with patients every 14 days instead of every month. The group then allegedly had its physicians bill those visits using inappropriate high-level procedure codes.

In connection with the settlement, PPOA entered into a five-year corporate integrity agreement with HHS Office of Inspector General, the Justice Department said. Under the agreement, PPOA said it will undertake significant compliance efforts.

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