Attorney General Tong Announces $4.2 Million False Claims Settlement with Orange Physician(Hartford, CT) – Attorney General William Tong today announced a $4.2 million joint state and federal settlement with physician Jasdeep Sidana and his businesses DOCS Medical Group, Inc., DOCS Medical Inc., DOCS Urgent Care LLP, Lung Docs of CT, P.C., Epic Family Physicians, LLP and Continuum Medical Group, LLC. Dr. The settlement resolves allegations that Sidana and his businesses submitted false claims for payment to Medicare and the Connecticut Medicaid program for medically unnecessary allergy services, unsupervised allergy services, and services improperly billed as though provided by Sidana. The agreement also resolves allegations that Sidana and DOCS improperly billed for certain office visits associated with COVID-19 tests.
Sidana is a physician who specializes in pulmonology and is the owner and Chief Executive Officer of DOCS, a medical practice with more than 20 facilities throughout Connecticut that offers a variety of services to its patients, including primary and urgent care, allergy testing and treatment, and COVID testing.
Medicare and Connecticut Medicaid pay only for services or items that are medically necessary. Some services also have supervision requirements, and allergy tests and the preparation of allergy immunotherapy must be directly supervised by a physician. Direct supervision requires the supervising physician to be present in the same office suite, and immediately available to render assistance if needed.
In early 2014, DOCS and Sidana started providing allergy testing and treatment services to their patients. The government alleges that between October 1, 2016, and September 30, 2017, DOCS and Sidana submitted false claims to Medicare and Medicaid for immunotherapy services that were not medically necessary, and were not directly supervised by a physician. The allegations also involve claims to Medicare and Medicaid for medically unnecessary annual re-testing of allergy patients between January 1, 2014, and November 11, 2018.
The government also alleges that between January 1, 2014, and January 1, 2019, DOCS and Sidana submitted claims for medical services performed by Sidana on dates of service when he was traveling internationally and did not perform or supervise the services. Instead, the services were actually performed by lower-level providers, who typically receive a lower reimbursement rate from Medicare and Medicaid for such services.
Finally, the government contends that when administering tests for COVID, DOCS and Sidana improperly billed Medicare and Connecticut Medicaid for certain evaluation and management (“E&M”) services, commonly referred to as office visits. The government alleges that between April 1, 2020, and December 31, 2020, on the same dates that patients received COVID-19 tests, DOCS and Sidana submitted claims for moderately complex “level 3” E&M services, when those level 3 office visits were not in fact provided.
In addition to the $4.2 million payment, Dr. Sidana must enter into an “Integrity Agreement” with multiple compliance requirements and conditions, including annual claims reviews by an independent reviewer.
“Dr. Sidana and his wide network of urgent care centers engaged in a long-running scheme to overbill the state and federal government for medically unnecessary treatment, as well as for treatment he and his team never provided. In addition to a $4.2 million penalty, Dr. Sidana and his clinic’s billing will be subject to ongoing oversight and scrutiny to ensure these unacceptable practices never occur again,” said Attorney General Tong.
“I join Attorney General Tong in condemning this affront to patients in Connecticut’s HUSKY Health/Medicaid program and the taxpayers who fund it. The $4.2 million settlement penalty is the result of extensive investigation and legal action by state and federal anti-fraud investigators and attorneys, and we are grateful for their dedication in protecting the integrity of our public health coverage services,” said Department of Social Services Commissioner Deidre S. Gifford.
The federal and state False Claims Act settlement was reached jointly with the U.S. Attorney's Office. The investigation was jointly conducted by the U.S. Department of Health and Human Services (HHS) Office of the Inspector General/Office of Investigations, the U.S. Attorney’s Office and the Office of the Connecticut Attorney General. The investigation followed a referral from the Connecticut Department of Social Services' Office of Quality Assurance. The settlement will reimburse both the federal and state shares of the Medicaid program.
Anyone with knowledge of suspected fraud or abuse in the public healthcare system is asked to contact the Attorney General’s Government Program Fraud Section at 860-808-5040 or by email at firstname.lastname@example.org; the Medicaid Fraud Control Unit at 860-258-5986 or by email at email@example.com; or the Department of Social Services fraud reporting hotline at 1-800-842-2155, online at www.ct.gov/dss/reportingfraud, or by email to firstname.lastname@example.org.
Forensic Fraud Examiner Thomas J. Martin and Gregory K. O'Connell, Chief of the Government Program Fraud Section, assisted the Attorney General in this matter.