Virginia Physician and Practice Settle False and Fraudulent Claims Case

On December 29, 2017, The Female Pelvic Medicine Institute of Virginia, P.C., and Nathan Guerette, M.D. (collectively, Dr. Guerette), a urogynecology practice and physician with locations in Richmond and North Chesterfield, Virginia, entered into a $1,401,344 settlement agreement and a 3-year integrity agreement with OIG. The settlement agreement resolves allegations that Dr. Guerette submitted claims to Federal health care programs for items or services that he knew or should have known were not provided as claimed or were false or fraudulent. Specifically, OIG contended that Dr. Guerette submitted claims for: (1) pelvic floor therapy services that were provided by unqualified individuals; (2) diagnostic electromyography services under CPT Code 51784 that had not been performed according to the requirements of the indicated code; (3) unbundled biofeedback and physical therapy procedures; and (4) "incident to" services that lacked the required level of physician supervision. OIG also contended that Dr. Guerette submitted claims for electromyography services under CPT Code 51784 and anorectal manometry services under CPT Codes 91120 and 91122 that were not supported by adequate medical record documentation. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsels Michael Torrisi and David Traskey with the assistance of Paralegal Specialist Mariel Filtz, collaborated to achieve this settlement.

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