Dimitri Dermatology Sued for Medicare and Medicaid Fraud by Whistleblowers Under the False Claims Act

All statements herein are allegations. The defendants deny liability and are presumed not liable unless and until the allegations are proven in court.

Case Overview:

This qui tam action involves allegations of widespread and persistent billing fraud by Dimitri Dermatology and its associated entities. The government in intervention alleged that defendants submitted claims to Medicare and Medicaid that were upcoded, contained intentional misdiagnoses intended to obtain higher reimbursements, and/or were for medically unnecessary procedures. The fraudulent practices reportedly resulted in millions of dollars in overpayments from federal and state healthcare programs.

Defendants:

The primary defendant, E.M. Dimitri, D.O., operates multiple dermatology clinics across Louisiana and Mississippi through various affiliated entities. These clinics provide services through various corporate entities, including Dimitri Dermatology, Mississippi Dermatology, and others. Additional medical professionals named in the complaint include Dr. Joel Perdomo and Dr. Steven Shapiro, who are alleged to have participated in or approved the fraudulent billing practices.

Allegations:

On July 24, 2018, relators filed their complaint under the federal False Claims Act (FCA) and Louisiana’s Medical Assistance Programs Integrity Law (MAPIL), alleging that under Dr. Dimitri’s direction, the defendants engaged in a range of fraudulent activities:

1. Misdiagnoses and Unnecessary Procedures:

• The defendants allegedly routinely misdiagnosed patients to justify medically unnecessary treatments, such as phototherapy and Botox injections.
• The defendants allegedly falsely billed cosmetic Botox injections, which are not reimbursable by Medicare, as treatments for medical conditions like chronic migraines and axillary hyperhidrosis.

2. Upcoding, Unbundling and False Billing:

• The defendants allegedly upcoded services to secure higher reimbursements. Less complex procedures were billed at higher levels and visits were billed as taking longer than they actually had; and services provided by nurse practitioners were billed under the names of physicians.
• Defendants also allegedly divided treatments into unnecessary multiple sessions to increase billings which is sometimes referred to as unbundling.

3. Ineligible Providers:

• The complaint alleges that services performed by providers who were not enrolled in Medicare or Medicaid were falsely billed under the names of enrolled providers, violating both federal and state regulations.

4. Inappropriate Botox Dilution:

• The defendants allegedly diluted Botox injections beyond the manufacturer’s recommended levels, reducing the efficacy of the medical treatment while still billing at full price to Medicaid and Medicare.

Legal Framework:

• False Claims Act (FCA): This federal law allows private individuals (known as whistleblowers or relators) to file lawsuits on behalf of the government for fraudulent claims made to Medicare, Medicaid, and other government programs. Violations of the FCA may result in treble damages and civil penalties.
• Louisiana Medical Assistance Programs Integrity Law (MAPIL): Similar to the FCA, this state law holds healthcare providers accountable for submitting false claims to Louisiana Medicaid.

Procedural History and Current Status:

The U.S. government and the State of Louisiana intervened after investigating the allegations, and filed their complaint in intervention on September 25, 2024, adding claims of fraud upon the Mississippi Medicaid program. The case is currently in the discovery phase, following the court’s denial of the defendants’ motion to dismiss the federal and state claims. The United States, the State of Louisiana, and the relators through their private whistleblower law firm Brown, LLC continue to try to pursue a recovery on behalf of the taxpayers through the litigation.

Read the relators’ original complaint and the First Amended Joint Complaint:

• Complaint
• First Amended Joint Complaint

Contact Information:

If you have information relevant to this case or believe you have knowledge of similar healthcare billing fraud, please contact Brown, LLC’s whistleblower attorneys at (877) 561-0000.

Medicare and Medicaid billing fraud harms taxpayers and undermines the integrity of federal healthcare programs. The False Claims Act allows whistleblowers with inside knowledge of fraud to file lawsuits on behalf of the government and share in any recovery obtained through the case.

Disclaimer Regarding Allegations

The statements above summarize allegations contained in court filings in an ongoing case. The defendants dispute the allegations, and no findings of liability have been made. All parties are presumed not liable unless and until the claims are proven in court.