Southern Spine & Pain Institute Settles False Claims Act Suit for $430,000

Relators to receive 19.5% share of recovery.

"When physicians bill the government for medical services that are not needed by the patient, they violate the trust placed in them by their patients and the government to provide only medically necessary care."
U.S. Attorney John Horn

Bracker & Marcus LLC is pleased to announce that the United States and State of Georgia have settled allegations of wrongdoing by Southern Pain Institute, P.C, and its owner, Dr. Anthony Clavo. SPI operated three medical offices in the Atlanta area, as well as an ambulatory surgical center and pharmacy, treating patients with pain and related disorders. The United States and the State intervened and settled allegations that SPI submitted claims for services that were not medically necessary and where there was insufficient information in the medical records to support procedures performed and billed to Medicare and Medicaid.

"Delivering medically unnecessary treatment or failing to document the need for that care can be a serious threat to the health of the patient as well as the federal programs they depend upon."
HHS OIG SAC Derrick L. Jackson

Two brave women reported SPI in a qui tam action, after choosing to resign from the practice rather than participate in the fraud. Both had serious concerns that patients were being put in harm's way. Herretta Pickens was Dr. Clavo's nurse practitioner. She discovered that SPI had not maintained the medical records necessary to properly treat her patients and formed a belief that patients were being subjected to unnecessary procedures. Teresa Williams was a front office administrator, and she too harbored concerns that patients were being scheduled for procedures that they did not need. Things got so bad that in a single 24-hour period in March of 2015, they both quit, in response to separate incidents, without having had any prior discussion about doing so or bringing an FCA action together. Just a few months later, in July 2015, the two whistleblowers found each other, and Bracker & Marcus LLC filed a False Claims Act case on their behalf.

"Fighting Medicaid fraud has been and will remain a top priority for our office. People who misuse our medical systems divert funds from those in need of care and abuse Georgia taxpayer dollars."
Georgia Attorney General Chris Carr

Attorney Jason Marcus spent his days working directly with federal and state investigators, attorneys, and agents, digging through medical records and building a robust case against SPI. Before the investigation could be completed, both SPI and Dr. Clavo filed for bankruptcy, and the medical practice was closed. SPI soon thereafter settled the claims against it for $430,000 plus interest. Ms. Pickens and Ms. Williams will split a relator's share of 19% and 21% of the federal and state recoveries, respectively. The relators also settled personal retaliation claims under the False Claims Act.

"Those individuals in positions of trust within the healthcare industry have an inherent duty to be forthright in their claims submittals to those government programs that pay for their services. Through the False Claims Act settlement and the associated monetary judgments announced today, the defendant in this case, Dr. Anthony Clavo, understands this and the U.S. Government's position on this a lot better."
George Crouch, Acting Special Agent in Charge, FBI Atlanta Field Office

Bracker & Marcus LLC would like to thank and congratulate everyone who assisted with the prosecution of the case, including Assistant U.S. Attorney Lena Amanti, state Assistant Attorney General Sara Vann, and its co-counsel, Oscar Prioleau of Prioleau & Milfort, LLC.