Newton Physician to Pay $680,000 to Resolve Allegations of Medicare and Medicaid Fraud

BOSTON – The U.S. Attorney’s Office announced today that Dr. Hooshang Poor, a Newton geriatric medicine physician, has agreed to pay $680,000 to resolve allegations that he violated the False Claims Act by submitting inflated claims to Medicare and the Massachusetts Medicaid program (MassHealth) for care rendered to nursing home patients.

In the settlement agreement, the government contends that, between May 31, 2017, and June 1, 2011, Dr. Poor submitted inflated claims for nursing home care by assigning false procedural codes that overstated the length, extent, and scope of services he and his employees furnished to nursing home residents. The government further contends that Dr. Poor did not abide by MassHealth limitations on the frequency of billable visits and did not use required modifier codes when billing for care his non-physician employees provided, causing MassHealth to reimburse inflated amounts for those services.

“Dr. Poor enriched himself at taxpayer expense by improperly billing Medicare and Medicaid,” said United States Attorney Andrew E. Lelling. “We will continue to work with our law enforcement partners to ensure that federal and state health care dollars are spent properly.”

“It’s our agency’s mission to ensure government health funds are spent properly,” said Special Agent in Charge Phillip M. Coyne of the U.S. Department of Health and Human Services Office of Inspector General. “Working with our Federal and State partners, we will continue to hold accountable any medical professional who bills Medicare and Medicaid for more intensive and expensive services than those actually provided.”

Under the terms of the agreement with the United States and the Commonwealth of Massachusetts, Dr. Poor will pay $265,896 to the Medicare program and $414,103 to the Medicaid program.

U.S. Attorney Lelling and HHS-OIG SAC Coyne made the announcement today. This matter handled by Assistant U.S. Attorney David J. Derusha of Lelling’s Office and Assistant Attorneys General Kevin Lownds and Gregory Matthews of the Massachusetts Attorney General’s Medicaid Fraud Division.