Missouri Doctor Settles Health Insurance Fraud for $1.2M

Dr. Nehal Modh, the owner of Progressive Pain Management in Festus, Missouri, has reached a $1.2 million settlement with the federal government to resolve allegations of submitting false claims to Medicare and Missouri Medicaid. The U.S. Attorney for the Eastern District of Missouri announced that Modh falsely claimed the use of ultrasound guidance for certain pain management injections and submitted inaccurate claims for joint injections that did not meet billing requirements.

Linda T. Hanley, a special agent from the U.S. Department of Health and Human Services Office of Inspector General, emphasized the impact of health care fraud on taxpayers and vulnerable beneficiaries. The settlement reflects the doubled restitution required under the False Claims Act, totaling $600,000, which is then doubled as a penalty.

The False Claims Act also allows for whistleblowers to be compensated for their role in exposing fraud. Donna Chronister, a former employee at Modh’s practice, will receive $177,707 for filing the lawsuit on behalf of the U.S. government. U.S. Attorney Sayler Fleming expressed gratitude for Chronister’s actions, highlighting the importance of civil enforcement efforts in collaboration with whistleblowers to protect the public.