Government Settles False Claims Act Allegations Against American Access Care Holdings, LLC

American Access Care Holdings, LLC, which operated a vascular access center in Miami, has agreed to pay $1.2 million to resolve allegations that it violated the False Claims Act by billing Medicare for medically unnecessary percutaneous transluminal angioplasties (PTAs) and thrombectomies and by billing for more PTAs per patient encounter than permitted.  Former American Access Care (AAC) facilities, including the one in Miami, are now operated by Fresenius Vascular Care, Inc.  The conduct addressed by the settlement agreement took place prior to the merger between the two entities.

Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, and Shimon R. Richmond, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), Miami Region, made the announcement.

“Health care providers that bill for medically unnecessary procedures put their own financial self-interest over their duty to their patients’ well-being,” said Wifredo A. Ferrer, United States Attorney for the Southern District of Florida.  “We will hold providers accountable for this type of fraud and abuse that plagues the Medicare program and increases the cost of health care for all.”

“Jeopardizing patient care in order to steal taxpayer dollars is deeply troubling,” said Shimon R. Richmond, Special Agent in Charge, Office of Inspector General of the U.S. Department of Health and Human Services.  “Actions like these only strengthen our resolve to protect the American public and hold accountable those who would compromise our health care system.”

The United States alleged that a substantial percentage of the PTAs and thrombectomies billed by the AAC facility in Miami were unnecessary, based on a medical review of patient records.  Patients at the facility were routinely brought back for follow-up visits that were not justified by the patients’ condition and that simply provided more opportunities to bill for procedures the patients did not need.  The United States also alleged that AAC billed for multiple PTAs performed during one patient encounter, even though it knew that such procedures were not reimbursable.

The settlement announced today resolves allegations originally brought by Dennis Souza, a registered nurse who worked at American Access Care of Miami, under the qui tam or whistleblower provisions of the False Claims Act, which permit private parties to sue on behalf of the United States for the submission of false claims and to receive a share of any recovery.  The False Claims Act authorizes the United States to intervene in such lawsuits and take over primary responsibility for litigating them, as the United States did here.  Souza’s share of the settlement has not yet been determined.

The investigation of this matter reflects a coordinated effort between the U.S. Attorney’s Office for the Southern District of Florida and HHS-OIG.  The case was handled by Assistant U.S. Attorney Susan Torres.

The case is captioned United States ex rel. Souza v. American Access Care of Miami, LLC, No. 11-22686-Civ-Lenard (S.D. Fla.).  The claims settled by the lawsuit are allegations only, and there has been no determination of liability.      

A copy of this press release may be found on the website of the United States Attorney’s Office for the Southern District of Florida at www.usdoj.gov/usao/fls. Related court documents and information may be found on the website of the District Court for the Southern District of Florida at www.flsd.uscourts.gov or on http://pacer.flsd.uscourts.gov.