Danville pharmacist to pay settlement for Medicare, Medicaid fraud

Piedmont Infusion Services and its owner, Jacob Patterson, have agreed to pay $310,000 to resolve allegations that they violated the False Claims Act and the Virginia Fraud Against Taxpayers Act by submitting false bills to Medicare and Medicaid.

Patterson, 66 of Danville, was a pharmacist who owned and operated Piedmont Infusion Services, an infusion center that employed nurses and nursing assistants to provide patients with not only compounded prescriptions but also needle and catheter method medications ordered by their physician.

Piedmont Infusion Services did not employ a physician or “physician extender” such as a physician’s assistant to provide patient care, according to the Department of Justice. From 2013 through 2018, Patterson and Piedmont Infusion Services falsely and knowingly billed Medicare and Medicaid for high-level office visits that did not occur.

They consistently and improperly billed for CPT code 99215, which is only appropriate when a physician or other qualified medical professional provides evaluation and management of an established patient who presents problems of moderate to high severity.  To be appropriate, the appointment must include at least two of these three key components: a comprehensive history, a comprehensive examination, and/or medical decision-making of high complexity.  Patterson and Piedmont Infusion Services did not provide this care to patients, nor could they have appropriately done so because they did not employ a physician or other qualified medical professional to provide this care.

In addition to falsely billing for non-existent high-level office visits, Patterson and Piedmont Infusion Services also knowingly and fraudulently double-billed Medicare Part B for medications already billed to Medicare Part D.

“Providers who fraudulently bill Medicare defy basic requirements for their participation in the program and wrongfully attempt to collect taxpayer funds,” said U.S. attorney Christopher R. Kavanaugh. “Here, because a former employee came forward, we learned that patients were not receiving the care that Jacob Patterson and Piedmont Infusion Services claimed to provide. They also did not receive some of the medications for which the government paid. Providers must honestly represent the drugs and services provided and follow the rules in place to protect patient safety. To do otherwise is fraud.”

A former employee of Piedmont Infusion Services came forward as a whistleblower and assisted the government in investigating this matter.