ST. LOUIS – The U.S. Department of Justice and the owner of a Festus pain management clinic reached a civil settlement Tuesday over allegations the owner submitted doctored claims to Medicare and Missouri Medicaid.
Prosecutors with the U.S. Attorney’s Office for the Eastern District of Missouri said Dr. Nehal Modh owned and served as president of Progressive Pain Management in Festus.
Under the settlement, Modh acknowledged that he and PPM lied to both federal health care programs that ultrasound guidance was used on certain pain management injections, that they submitted false claims for payment for facet joint injections that didn’t meet billing requirements, and that they improperly coded claims in order to receive larger reimbursements.
A former PPM employee alerted the authorities to the fraud under the whistleblower provisions of the False Claims Act (FCA). Under those provisions, a whistleblower can be eligible to receive a portion of the recovered funds.
As part of the settlement, Modh and PPM must repay restitution in the form of $600,000 each. The whistleblower will receive $177,707 of that settlement.
