Date: 03-17-2015

Case Style: United States of America v. Coastal Dermatology, and Dr. Sanjiva Goyal.

Case Number: None

Judge: Not Available

Court: United States District Court for the Middle District of Florida (Duval County)

Plaintiff's Attorney: Jason Mehta

Defendant's Attorney: Not Available

Description: Jacksonville, FL - The United States settled allegations that a Jacksonville-based dermatology practice knowingly billed the government for services that were cosmetic in nature and not medically necessary, as well as “up-coded” certain bills to receive higher than allowed reimbursement. The allegations resolved included liability under the False Claims Act (FCA).

The government announced today that it has reached a settlement with the defendant, Coastal Dermatology, and the physician who owned the practice – Dr. Sanjiva Goyal. In reaching this settlement, the parties resolved allegations that from January 1, 2009, until April 2014, Dr. Goyal operated a dermatology practice that routinely had a practice of billing for cosmetic dermatological procedures, billing for services when all the Medicare and TRICARE requirements were not established, and billing for services at a higher rate of reimbursement than appropriate. The government agreed to accept $787,814 to resolve these allegations.

This settlement involved false claims submitted to both the Medicare and TRICARE programs. This case was developed by proactively mining healthcare reimbursement data. In mining through this data, Coastal Dermatology was identified as a top biller of procedures related to skin lesion removal procedures and removal of inflamed seborrheic keratoses. Among the 3,814 TRICARE-participating dermatologists in the South Region, Coastal Dermatology was number one in terms of billings for lesion removals.

"The United States Attorney's Office is committed to taking the steps necessary to protect Medicare, TRICARE, and other federal health care programs from fraud," said U.S. Attorney Bentley. "By bringing FCA cases such as this, we hope to recover funds obtained through the fraud and deter others from attempting similar schemes."

"Patients unable to receive necessary medical care suffer the cost of Medicare fraud when those funds are purposely stolen and diverted to pay for uncovered voluntary procedures," stated Special Agent in Charge Derrick Jackson of the U.S. Department of Health and Human Services Office of Inspector General. "We will continue to work with our law enforcement partners to protect the integrity of entitlement programs like Medicare."

This settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by the Department of Justice and the Department of Health and Human Services. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in this effort is the False Claims Act. Since January 2009, the Justice Department has recovered a total of more than $19 billion through False Claims Act cases, with more than $13.4 billion of that amount recovered in cases involving fraud against federal health care programs.

"This settlement highlights the commitment of the Defense Criminal Investigative Service (DCIS) and its law enforcement partners to protect the integrity of the Department of Defense (DoD) health care program," said Special Agent in Charge John F. Khin, Southeast Field Office. “DCIS' aggressively investigates health care providers that defraud the DoD, to preserve American taxpayer dollars intended to care for our Warfighters, their family members, and military retirees."

This case was investigated by the Defense Criminal Investigative Service (DCIS), Health and Human Services Office of Inspector General (HHS/OIG), HHS Office of Counsel to Inspector General (HHS/OCIG), the Defense Health Agency Program Integrity Office, and Assistant United States Attorney Jason Mehta.

The claims resolved by this settlement are allegations only, and there has been no determination of liability.

Outcome: See above

Plaintiff's Experts:

Defendant's Experts:

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