Pain management physician resolves Georgia False Medicaid Claims Act allegations
ATLANTA, GA –Georgia Attorney General Chris Carr joined the United States Attorney’s Office for the Northern District of Georgia, the United States Attorney’s Office for the Eastern District of Kentucky and Attorney General Andy Beshear of the Commonwealth of Kentucky this week in announcing that pain management physician, Dr. Robert Windsor, has agreed to the entry of a $20 million consent judgment to resolve allegations that he violated the Georgia False Medicaid Claims Act, the federal False Claims Act and other state laws and regulations by billing federal healthcare programs, including Georgia Medicaid, for medically unnecessary diagnostic tests and for billing Medicare and Tricare for surgical monitoring services that he did not perform. Dr. Windsor owned pain management clinics in Georgia and Kentucky that operated under the umbrella of National Pain Care, Inc.
“Providers have a responsibility to ensure that their services are medically necessary and appropriate before they bill the Medicaid program,” said Attorney General Carr. “The Office of the Attorney General is committed to holding Medicaid providers accountable for seeking payment for unnecessary medical procedures. We would like to thank our federal colleagues and the Kentucky Medicaid Fraud Control Unit for their close cooperation in this investigation.”
The government alleges that Dr. Windsor engaged in two schemes. First, the government alleges that Dr. Windsor submitted or caused the submission of false claims to Medicare, the Georgia and Kentucky Medicaid programs, TRICARE, and FEHBP for medically unnecessary balance tests, nerve conduction and electromyography procedures, and qualitative drug screens performed in Georgia and Kentucky during the period from Jan. 1, 2010 through June 30, 2014.
Second, the United States alleges that Dr. Windsor caused the submission of false claims to Medicare, TRICARE, and FEHBP for the online, real time intraoperative monitoring of surgeries that Dr. Windsor did not personally monitor, that were not monitored by a physician, and that Dr. Windsor falsely represented had been monitored by him during the period from Jan. 1, 2008 through July 22, 2013. On Oct. 24, 2016, Dr. Windsor was sentenced to three years, two months in federal prison and three years of supervised release in connection with this conduct.
In order to satisfy the $20 million consent judgment, Dr. Windsor will sell all but one of his residential and commercial properties and pay the net sale proceeds to the government. Dr. Windsor will also sell certain other assets, including two boats and four jet skis, and pay the net sale proceeds to the government.
The settlement, in part, resolves a lawsuit filed by a whistleblower Kris Frankenberg under the qui tam provisions of the federal False Claims Act and the Georgia False Medicaid Claims Act. The lawsuit is captioned United States ex rel. Frankenberg v. Windsor et al., No. 1:12-cv-3114 (N.D. Ga.). Mr. Frankenberg will receive from the State of Georgia a share of the settlement payment that resolves the qui tam suit that he filed.
This case was investigated by the Office of the Attorney General’s Medicaid Fraud Control Unit (MFCU), including Investigator Tonia Medlin, Investigative Auditor Denise Colson and Analyst Kirste Young, in coordination with the Kentucky Medicaid Fraud Control Unit, the U.S. Attorney’s Office for the Northern District of Georgia, the U.S. Attorney’s Office for the Eastern District of Kentucky, the U.S. Department of Health & Human Services Office of Inspector General, the Federal Bureau of Investigation and the Defense Criminal Investigative Service.
The civil settlement was reached by The Office of the Attorney General’s Assistant Attorney General Elizabeth White.
Georgia Pain Physicians Clinic of Calhoun, founded by Dr. Windsor, closed its doors Aug. 10, 2016. Center for Spine and Pain Medicine, operated by Dr. Sadiq Sohani, moved into the location in late August 2016.