United States Attorney William M. McSwain announced that Pramod Pilania, M.D., has agreed to pay $91,109 to resolve potential liability under the False Claims Act. Dr. Pilania was a psychiatrist who previously saw patients at the Northeast Community Mental Health Centers in Philadelphia and the Lehigh Valley Community Mental Health Centers, with locations in Allentown, Bethlehem, and Reading. According to the settlement, the United States contends that Dr. Pilania claims to have seen more than 120 Medicaid patients, including children, on a single day on several occasions in 2010. On each of the dates when he supposedly saw in excess of 120 patients, he also travelled between the Northeast clinic in Philadelphia and the Lehigh Valley clinic in Allentown, which are separated by approximately an hour’s drive. At the time of Dr. Pilania’s patient visits, Medicaid administrators required the “medication management” or “med check” visit to be 15 minutes in duration and also required the practitioner to record the time each visit began and ended on patient encounter forms. Seeing 120 patients for 15 minutes each would take 30 hours. According to the settlement agreement, Dr. Pilania did not see some of the 120-plus patients on those six dates for 15 minutes. Instead, many of the encounters were of extremely short duration. The settlement also alleges that Dr. Pilania did not record the beginning and ending times on patient encounter forms. This False Claims Act settlement with Dr. Pilania was preceded by a separate, related civil healthcare fraud lawsuit filed in 2015 against the Northeast and Lehigh Valley clinics where Dr. Pilania served as the Medical Director.
