Improper Billing of FEHB, Medicare Leads to $750,000 Settlement

A $750,000 settlement, with $135,000 for a whistleblower, has been reached with a doctor for improper billing under the FEHB and Medicare.

Health insurance form and dollars on the table

Dr. Paul B. Tartell, an ear, nose and throat physician practicing in Florida and his practice Paul B. Tartell, M.D., P.L., have agreed to pay $750,000 to resolve allegations he violated the False Claims Act.

Billing of FEHB and Medicare

The settlement involves the Federal Employee HealthBenefits Program (FEHB). The government alleged that Dr. Tartell systematically billed Medicare and the FEHB for claims arising from medical procedures that were not performed or were not medically necessary.

Whistleblower Provisions of the False Claims Act

The allegations were originally brought by Theodore Duay. He was a former patient of Dr. Tartell. Duay filed a complaint under the qui tam, or whistleblower, provisions of the False Claims Act. This permits private parties to sue on behalf of the government and receive a share of any recovery.

The False Claims Act authorizes the Federal Government to intervene in the lawsuits and take over primary responsibility for litigation. Mr. Duay will receive $135,000 as a result of this case.

“When physicians and their practices bill for services not provided or not medically necessary it undermines the public’s trust in medical institutions and the financial integrity of federal health care programs,” said Shimon R. Richmond, Special Agent in Charge, HHS Office of Inspector General. “Our agents and lawyers will aggressively pursue those who exploit taxpayers, patients, and government health programs.”

Agencies Involved

The settlement announcement was made by Wifredo A. Ferrer, US Attorney for the Southern District of Florida, Shimon R. Richmond, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), George L. Piro, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office, and Scott Rezendes, Special Agent in Charge, U.S. Office of Personnel Management, Office of Inspector General (OPM-OIG).

About the Author

Ralph Smith has several decades of experience working with federal human resources issues. He has written extensively on a full range of human resources topics in books and newsletters and is a co-founder of two companies and several newsletters on federal human resources. Follow Ralph on Twitter: @RalphSmith47