Southwest Orthopaedic Specialists: The 2018 Ultrasound and Surgical-Assistant Settlement

In the Southwest Orthopaedic Specialists 2018 ultrasound settlement, the Oklahoma practice and nine physicians agreed to pay $670,000 over allegations of unnecessary ultrasound guidance and surgery-assistant services that were never performed. The government said the claims went to Medicare, Medicaid and Tricare. For an insider who knew the clinical work, the questions were concrete: why was the guidance used, and who actually did the work on the bill?

The Justice Department’s July 13, 2018 announcement described physicians who both practiced at and held ownership in Southwest Orthopaedic Specialists. A former employee brought the False Claims Act case. The settlement addressed two allegations about services billed to government health care programs.

How the Alleged Billing Worked

The ultrasound allegation concerned unnecessary procedures. The assistant allegation concerned work the government said was not performed. One turns on why the equipment was used, the other on whether the billed work happened.

Ultrasound Guidance for Needle Placement

The United States alleged that the practice and its physician owners caused false claims for unnecessary procedures involving ultrasonic guidance for needle placement, imaging supervision and interpretation. The alleged conduct ran from January 1, 2012, through September 22, 2016.

A broader whistleblower complaint against the practice described doctors routinely directing physician assistants to use ultrasound whenever possible, including when a doctor was not on site and in the room to supervise.

The complaint also described a warning from outside the clinical team. ALN, the practice’s third-party billing company, allegedly noticed a spike in CPT 76942 claims. The complaint says that on January 24, 2014, ALN told the doctors that each ultrasound use had to be medically necessary, documented and supervised when performed by a physician assistant. According to the complaint, ALN said payments for unnecessary or unsupervised services should be returned. The complaint alleges that the doctors then sharply reduced and eventually stopped using ultrasound for injections.

Another ultrasound case involved a different practice altogether. Southeast Orthopedic Specialists in Jacksonville, Florida reached a settlement in December 2016 over allegations including medically unnecessary ultrasound guidance and supervision problems. The recurring issue is what accompanied the ultrasound bill: a clinical reason for the service and the supervision represented.

An Assistant Billed in Two Places at Once

The government’s assistant allegation concerned Southwest Orthopaedic Specialists and one physician. It alleged that they caused claims for a surgery assistant who did not perform the billed services, from January 1, 2013, through December 31, 2015.

The whistleblower complaint described an operations manager raising concerns about assistant billing and an investigation that compared work in neighboring buildings:

In that account, the same assistant’s time appeared on bills for work in two places at once. The alleged mismatch was visible to someone who understood both the clinic’s work and the surgical billing. A procedure description alone would not tell that story.

The 2020 Journal of Forensic and Investigative Accounting paper A Forensic Accountant’s Guide to the Most Potent Federal Laws Used Against Healthcare Fraud discusses medical necessity and reimbursement requests that inaccurately list services provided. That distinction runs through the Southwest allegations: why was ultrasound used, and was the assistant there at all?

The Settlement Resolved Two Allegations

The government joined the two allegations covered by the agreement. Oklahoma was to receive part of the settlement because the allegations included Medicaid claims.

The Later OCOM Settlement Concerned Referrals

The OCOM resolution announced on July 8, 2020 concerned alleged improper payments to referring physicians and hospital and physician-group financial relationships. Southwest Orthopaedic Specialists was among the defendants in that later resolution. Its allegations included investment opportunities at Texas surgery facilities.

In that later settlement, the practice and two physicians agreed to pay $5.7 million to the federal government and $495,619 to Oklahoma. Those payments concerned the referral allegations. The earlier billing case asked what services were performed; the later case asked what financial benefits went to physicians who sent patients to the hospital.

What Evidence Is Needed to Prove Fraud?

The Southwest complaint shows why billing knowledge and clinical knowledge belong together. We help insiders connect what they saw with the claims the government paid. Here, the whistleblower alleged that an assistant was working in the clinic while being billed for surgery next door, and that a billing company’s warning preceded a change in ultrasound use.

A device representative working beside the surgical team may know who was in the room even without seeing the bill. A June 2011 Senate Finance Committee minority-staff report on implant distribution described manufacturer representatives supplying instrumentation, stocking services and assistance to surgeons in the operating room. For an insider who sees an assistant billed for work they did not witness, that operating-room perspective can matter alongside the billing employee’s account.

That presence can also leave a written record. In its position statement reaffirmed in 2025, the Association of periOperative Registered Nurses calls for documenting an industry representative’s name, company and time in the room in the intraoperative nursing record. Connecting those accounts means understanding each person’s role, the work they saw and the service billed. That is where our whistleblower experts work with the insider and healthcare fraud whistleblower lawyers who know surgical billing.

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

You Know the Work Behind the Bill

If you worked in the clinic, handled its bills or supported the surgical team as a device representative, you may know where the claims departed from the work. Talk with our whistleblower experts about the ultrasound instructions, assistant schedules or billing warnings you saw. We stay beside you to build your strongest healthcare whistleblower case, with healthcare fraud whistleblower lawyers who understand surgical billing.