Premier Vein Centers: Unqualified Injectors and Unnecessary Procedures

In the Premier Vein Centers settlement, the clinic’s physician owner agreed to pay $400,000 to resolve allegations that he billed Medicare for vein injections and physician office visits performed by unqualified personnel. A former office manager brought the case, connecting what happened inside the clinics to what Medicare was told. If you know who performed the treatment, whose instructions they followed or whose number went on the claim, your knowledge reaches behind the bill.

The Vein Clinic and the Missing Physician

The government alleged that the physician owned and operated Premier Vein Centers in the Tampa area between 2009 and 2010. Beginning in 2009, he allegedly sent text messages directing his office manager to perform varicose-vein injections while he was away from the office. We see the problem plainly: a text message can convey an order, but it cannot give an office manager the qualifications to perform an invasive procedure.

The allegations also covered what happened when the physician was present. The government said he performed unnecessary vein injections and unnecessary ultrasound imaging associated with those injections. The Justice Department framed the use of unqualified personnel as a threat to patients’ health for personal gain and convenience.

The Weight-Loss Clinic and the Physician Number

Life’s New Image, the physician’s weight-loss clinic in the Tampa area, supplied a separate billing allegation. The government alleged that unqualified personnel met with patients, while the physician billed those encounters as physician office visits using his own Medicare provider number. He owned and operated this clinic during the same period as Premier Vein Centers.

The alleged substitution happened between the encounter and the claim: a staff member met the patient, but Medicare received a bill for a physician office visit. An employee who remembers the encounter can explain something the provider number alone leaves out: who was actually in the room.

What the Medicare Claim Should Match

The actual worker, the service and the billing identity need to be connected. In incident-to billing, the evidence includes the initial personal service, continuing involvement in treatment, staff qualifications and required supervision. Owning the practice or signing the chart doesn’t make the physician the one who did the work. We compare those records with the service billed and the supervision requirements for that setting and date.

The ordinary records of a clinic can answer different parts of that question. A schedule can show who was working, the treatment record can identify who performed the service, and supervision records can show the physician’s involvement. The submitted claim then shows how the practice represented that work to Medicare. These are the connections we examine with an insider who knows why the records agree, or why they do not.

Why the Ultrasound Matters

The unnecessary-ultrasound allegation adds the clinical reason for treatment to the billing question. Medical necessity fraud can turn on the measurements, symptoms, test results or treatment history used to justify a procedure. For a vein-clinic insider, the meaningful comparison is between that underlying information, the reason recorded for the order and the service billed to the government.

The Robert Wood Johnson Foundation’s 2008 report, Physician Self-Referral and Physician-Owned Specialty Facilities, explains why imaging deserves attention inside a practice. Fee-for-service payment rewards volume, and revenue from the technical component of imaging can require little additional physician time.

Tri-City Cardiology and its physician shareholders agreed to a $4,750,000 settlement over allegedly unnecessary perforator-vein ablations. In that case, the Justice Department described incorrect measurements or documentation of outward blood flow, vein diameter, symptoms and conservative treatment used to justify the procedures. The parallel is the clinical premise behind the bill: what information made the procedure appear necessary? An insider who knows how a measurement or history entered the chart can explain that connection.

The Settlement and the Integrity Agreement

The Justice Department announced the Premier Vein Centers settlement on January 7, 2014. The physician had closed both clinics in 2010, but the resolution also addressed his federal health care billing through a three-year integrity agreement with the Department of Health and Human Services Office of Inspector General. It required training courses provided by the Centers for Medicare and Medicaid Services and independent external review of his coding and billing procedures.

The former office manager’s qui tam case under the False Claims Act raised the allegations that the settlement resolved, and the announcement provided for a reward to her. The Justice Department’s Civil Division, the U.S. Attorney’s Office for the Middle District of Florida and the Health and Human Services Office of Inspector General investigated.

What Evidence Does a Whistleblower Need?

A whistleblower needs evidence connecting the claim to the care, the instructions and the people behind it. Here, that connection begins with who performed the injection or visit, what the physician directed, why the ultrasound was ordered and what Medicare was billed. The schedule, treatment record and submitted claim give different views of the same service.

The 2017 Journal of AHIMA article Busting Bad Medicine: A Call to Action Addressing Healthcare, Fraud, Waste, and Abuse makes that evidence connection concrete. It describes checking the treatment date, type of treatment and nurse or physician signature, then explains why the documents need people who understand them:

That is the value of knowing the practice from inside. A bill can identify a physician while an employee can explain who treated the patient and who directed the work. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. We work with you to connect that firsthand knowledge to the government’s money and the decisions behind the billing.

You Know Who Treated the Patient

If a physician’s number concealed the work you saw, or unnecessary procedures became part of the clinic’s routine, speak to one of our Whistleblower Experts about whose work went under the physician’s number. We build your strongest physician billing whistleblower case with you, bring in healthcare fraud whistleblower lawyers who understand physician billing and medical necessity, and stay beside you as the case moves forward.