The United States filed suit in US District Court for the Southern District of Illinois against General Medicine, P.C. (“General Medicine”), Thomas M. Prose, M.D. — the owner of General Medicine, and seventeen related corporate entities owned by Prose. In a 96-page complaint, the government alleges defendants violated the False Claims Act in a widespread healthcare fraud scheme involving the submission of thousands of false claims to the Medicare program. Since 2016, Medicare has paid defendants over $40 million dollars. General Medicine and the other defendant companies owned by Prose are based in Novi, Michigan and employed physicians and nurse practitioners to treat patients in nursing homes and assisted living facilities in numerous states, including Illinois and Missouri.
The government’s complaint alleges defendants knowingly billed Medicare for visits with facility residents that were not medically necessary, did not meet the requirements of the billing codes, or were not performed at all. As alleged in the complaint, these visits resulted from General Medicine directing their physicians and nurse practitioners to meet visit quotas and perform numerous patient visits and assessments each month without any consideration as to whether the patients needed the services. Defendants also allegedly submitted inflated claims to Medicare using billing codes for complex, comprehensive visits when the providers spent only minimal time with patients. On multiple occasions, defendants allegedly completed progress notes containing inaccurate information or embellished portions of the notes to bill the visits using codes with higher reimbursement rates.
