Physician, emergency department staffing company face allegations of Medicare fraud

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A physician faces charges for alleged health care fraud for allegedly billing Medicare and Medicaid for services he did not perform.

Meanwhile, the U.S. Department of Justice (DOJ) settled a civil lawsuit alleging fraud by a group of medical companies that billed Medicare using the names of physicians who did not work with them.

The cases were announced among recent actions involving the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), which investigates allegations of health care fraud with DOJ.

Assistant physicians employed

In the area around St. Louis, Missouri, physician Sonny S. Saggar, 55, and Renita Barringer, 50, were indicted for conspiracy and eight counts of making false statements related to health care matters. They have pleaded innocent to the charges, according to DOJ.

Saggar owned and operated the Downtown Urgent Care LLC, Creve Coeur Urgent Care LLC, and St. Louis General Hospital (SLGH), an urgent care and primary care clinic. Barringer was office manager and later a member of the board of directors at SLGH.

In Missouri, “assistant physicians” (APs) may treat patients under a collaborative practice arrangement with supervision by physicians, in medically underserved rural or urban areas.

“Dr. Saggar promoted SLGH as a ‘stepping stone’ for medical school graduates who had been unable to secure a residency and were ineligible to obtain a standard license to practice medicine,” according to DOJ. At least 39 APs worked there since January 2018 and Saggar and Barringer recruited physicians to “supervise” them by signing blank, undated collaborative practice arrangement forms, according to DOJ.

The APs received no training from those supervisors, despite mandatory requirements, and the Creve Coeur, Missouri, location was not a medically underserved area. Saggar allegedly hired a coconspirator who was indicted in another case to be the sole collaborating physician there, without informing Medicaid that the coconspirator was the sole physician there, according to DOJ.

Saggar and Barringer could face up to five years in prison and fines up to $250,000, according to DOJ. The Missouri Division of Professional Registration listed Saggar as a medical physician and surgeon board certified for internal medicine and emergency medicine.

Emergency services billing

In New York, DOJ announced a civil lawsuit and settlement with the companies Advanced Health Partners Inc., formerly known as Medicom Management Services Inc.; Medexcel USA Inc.; Medexcel Emergency Physician Services of Yonkers PLLC (MEPSY); and Tri-State Emergency Physicians PLLC.

From 2007 to 2017, MEPSY and Tri-State Emergency Physicians allegedly contracted to operate emergency departments at various hospitals around New York. Medexcel provided management services to those companies and back-office guidance to Advanced Health Partners. That company submitted several thousand claims using national provider identification numbers for physicians no longer employed by MEPSY or Tri-State, according to DOJ.

The companies involved will pay $475,000 in damages.

“This settlement holds these entities accountable both through the monetary payment and the detailed admissions they have made,” Damian Williams, U.S. attorney for the Southern District of New York, said in a statement.