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Former Rheumatologist Settles Civil Fraud Claims for $2 Million | #phishing | #scams | #cybersecurity | #infosecurity | #hacker



A former rheumatologist in Billings, Montana, and his business have agreed to pay more than $2 million to settle civil claims for alleged False Claims Act violations, according to Acting US Attorney for the District of Montana Leif M. Johnson.

Enrico Arguelles, MD, and his business, the Arthritis & Osteoporosis Center (AOC), which closed in September 2018, agreed to the settlement with the US Attorney’s Office on July 14.

Under terms of the settlement, Arguelles and the AOC must pay $1,268,646 and relinquish any claim to $802,018 in Medicare payment suspensions held in escrow for AOC for the past 4 years by the Centers for Medicare and Medicaid Services.

Attempts to reach Arguelles or his attorney for comment were unsuccessful.

“This civil settlement resolves claims of improper medical treatments and false billing to a federal program. Over billed and unnecessary claims, like the ones at issue in this case, drive up the costs for providing care to the people who really need it,” Johnson said in a statement.

Among the allegations, related to diagnosis and treatment of rheumatoid arthritis, were improper billing for MRI scans, improper billing for patient visits, and administration of biologic infusions such as infliximab (Remicade) for some patients who did not have seronegative rheumatoid arthritis, from January 1, 2015, through closure of the AOC office in 2018, the press release from the Department of Justice stated.

The press release notes that the settlement is not an admission of liability by Arguelles or AOC, nor a concession by the United States that its case is not well-founded.

Assistant US Attorney Michael A. Kakuk represented the United States in the case, which was investigated by the US Attorney’s Office’s Health Care Fraud Investigative Team, Department of Health and Human Services Office of Inspector General (HHS-OIG), and FBI.

Special Agent in Charge Curt L. Muller, of the HHS-OIG, said in the statement: “Working with our law enforcement partners, we will hold accountable individuals who provide medically unnecessary treatments and pass along the cost to taxpayers.”

According to the Billings Gazette, Arguelles’ offices in Billings were raided on March 31, 2017, by agents from the HHS-OIG, FBI, and Montana Medicaid Fraud Control Unit.

A spokesperson for the OIG did not disclose to the Gazette the nature of the raid or what, if anything, was found, as it was an open investigation.

In the month after the raid, the Gazette reported, the FBI set up a hotline for patients after a number of them began calling state and federal authorities with concerns “about the medical care they have received at Arthritis & Osteoporosis Center,” Katherine Harris, an OIG spokeswoman, said in a statement.

The settlement comes after the previous fiscal year saw significant recovery of funds for US medical fraud cases.

As Medscape Medical News has reported, the OIG recently announced that it had won or negotiated more than $1.8 billion in healthcare fraud settlements over the past fiscal year. The Department of Justice opened 1148 criminal healthcare fraud investigations and 1079 civil healthcare fraud investigations from October 1, 2019, through September 30, 2020.

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News, and Nurse.com, and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.

Follow Medscape on Facebook, Twitter, Instagram, and YouTube.





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