Colonial Family Practice, LLC, a physician-owned primary and urgent care practice with multiple clinics in South Carolina, has agreed to a $1.25 million settlement to resolve allegations that it violated the False Claims Act by billing Medicare, Medicaid, and TRICARE for medically unnecessary services. Specifically, the United States alleged that Colonial Family Practice filed claims for medically unnecessary nuclear stress tests ordered by Dr. Clay Lowder and Dr. David Whaley between February 22, 2012, and November 26, 2019. Further, the United States alleged the practice systematically billed for unnecessary Cystatin-C laboratory tests—a test to detect kidney dysfunction that is only payable in a narrow set of patients. Colonial Family Practice allegedly added this test to a panel run on most of its patients between August 13, 2013, and November 29, 2019. The allegations settled arose from two whistleblower lawsuits—one by a Physician Assistant formerly employed by Colonial and the other by a former clinical manager at the practice.
In United States ex rel. Debi Coker v. Colonial Family Practice LLC, et al., Civ. No. 3:18-cv-00800-JMC, the former clinical manager alleged that between February 2012 and November 2019 physicians at the practice falsified symptoms in medical records to support unnecessary EKGs, laboratory orders, and radiology services.
In United States ex rel. James Fields v. Colonial Family Practice, et al., Civ. No. 3:19-cv-02703-JMC, the Physician Assistant alleged that, between August 2013 and November 2019, Colonial created a protocol to add a Cystatin-C laboratory test to its Basic Metabolic Panel, which led to systematic billing for medically unnecessary Cystatin-C tests.
