Family Practice of Greater New Haven: The Appointment Went Online, the Cash Went to the Car

Family Practice of Greater New Haven and its physician paid $398,777 in a civil settlement involving telehealth over allegations of billing for medical services never provided and issuing medically unnecessary controlled-substance prescriptions. The telehealth episode in the Department of Justice’s account of the criminal case put the payment trail in plain sight: a patient working with investigators attended a FaceTime appointment, delivered cash to the doctor’s car, and obtained a prescription that Medicaid paid to fill. Medicaid funded the medication while the doctor collected cash for the prescription.

The practice operated on North Main Street in Wallingford, Connecticut, with an internal-medicine physician as its sole medical practitioner. It accepted patients insured by Medicare, Medicaid and commercial plans. The civil allegations involved Medicare and Medicaid patients, including patients prescribed oxycodone.

Cash for Prescriptions, Medicaid Bills for Visits

In its account of the criminal case, the Department of Justice reported that the physician pleaded guilty in December 2023 to health care fraud and conspiracy to distribute oxycodone. The announcement describes a patient paying for prescriptions while the physician also billed Medicaid for office visits. On four occasions between October 2019 and January 2020, a confidential source visited the office, handed the doctor $1,600 in cash and received a prescription for 150 oxycodone 30mg pills.

The doctor performed no physical examination and did not discuss the source’s health during those visits, according to that account. He nevertheless billed Medicaid for each office visit. The cash bought the prescription, and taxpayers were billed for a visit with no examination.

The same criminal-case account describes another cash payment for a prescription during an office visit on March 18, 2020. Then, on April 30, the appointment took place over FaceTime because of the COVID-19 pandemic. Afterward, the source delivered the same cash amount to the doctor’s car.

Drug Enforcement Administration agents collected the dispensed oxycodone as evidence after each fill. Medicaid covered the filled prescriptions.

The Prescribing Warnings Came Earlier

The criminal-case account places the prescribing concerns well before the remote appointment. The Drug Enforcement Administration and local police began receiving complaints around 2014. In early 2016, federal and state drug-control investigators told the physician they were concerned about his prescribing practices and that some of his patients had a criminal history.

Investigators then used Connecticut’s Prescription Monitoring Program and found continued high-volume prescribing of opioid pills, alprazolam and Adderall. The Department of Justice described one patient receiving monthly prescriptions for 170 oxycodone 30mg pills, 75 Adderall 20mg pills and 30 alprazolam 2mg pills for at least three years.

The same criminal-case account says investigators received information that some patients sold pills from medically unnecessary prescriptions for profit. Some patients also gave pills to the physician after filling their prescriptions. The prescription could supply both a resale business and the doctor who wrote it.

The Department of Health and Human Services’ inspector general joined the investigation around October 2019 after investigators discovered that patients were using Medicare or Medicaid to pay for medically unnecessary prescriptions. That brought the public insurance payments into an investigation already focused on prescribing. The same prescription could show up in a drug-monitoring inquiry and in a government health care claim.

What the Government Paid and What the Practice Settled

The civil settlement covered allegations from January 2016 through June 2020 about unprovided medical services and medically unnecessary prescriptions. The FaceTime encounter was one episode inside that wider case. The payment went to the federal and state governments.

The Department of Justice reported the completed civil payment in its May 22, 2024 announcement. It also said Family Practice was no longer operating.

The criminal investigation’s payment figures show the scale of the practice’s public-program business. From approximately January 2016 through May 2020, Medicare and Medicaid paid more than $1.6 million for Schedule II medications the doctor prescribed, including oxycodone. During the same period, they paid the practice more than $590,000 for routine office visits. Separately, the investigation identified $199,388 billed to Medicare and Medicaid for illegitimate office visits and unnecessary prescriptions.

Feel Well Health Center’s settlement, announced in November 2022, illustrates the broader scope a practice settlement can have. The government alleged improper office-service and purported-telemedicine billing alongside fitness visits billed as medical services, unnecessary testing and laboratory-payment arrangements. The practice and its physician agreed to resolve those allegations together.

What a Practice Insider Can Connect

A practice insider can connect what happened during an appointment to the prescription and the claim that followed it. In Family Practice’s case, investigators followed the patient-side cash, the doctor’s prescription, the filled medication and Medicaid’s payment. For the four office visits, they also described the missing clinical work and the visit bills.

That is where knowledge from inside a practice matters. A clinician may know what assessment supported an order. A biller may know which service the practice claimed and which insurer paid. A practice employee may know how appointments and cash payments were handled. We connect those accounts to the same patient, prescription and service date, so the clinical decision and the payment can be understood together.

What Are Some Examples of Prescription Fraud?

The Family Practice criminal case described prescriptions sold for cash without an examination or a discussion of the patient’s health. A separate Connecticut settlement shows how a remote prescriber could cause pharmacies to bill a public program for invalid prescriptions. In its September 2019 announcement about a physician working for CallMD, the Department of Justice alleged that the physician caused pharmacies to submit false claims to TRICARE by approving invalid compounded-medication prescriptions. The government said he had neither spoken with nor examined the patients and had no established treatment relationship with them. The physician agreed to pay $300,000.

The connection to Family Practice is the prescription’s role in generating a public-program bill. A prescriber’s decision reaches beyond the encounter when a pharmacy fills the order and seeks payment. That makes the clinical basis for the prescription part of the billing story.

How Much of a Settlement Does a Whistleblower Get?

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Saw the Visit Behind the Bill

If you know how cash, prescriptions and insurance claims moved through a practice, bring that account to our whistleblower experts. We build the case with you and bring in healthcare fraud whistleblower lawyers who understand controlled-substance prescribing and practice billing. We stay beside you as your firsthand knowledge becomes the basis for pursuing a recovery.