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Plastic Surgeon Settles False Claims Act Allegations, Agreeing to Pay $23.9 Million in Medicare and Medicaid Fraud Case

There are big bucks in plastic surgery and taxpayers are not supposed to foot the bill for elective cosmetic surgery, but even appropriate surgery like skin grafts can allegedly be replete with fraud.  The Department of Justice (DOJ) announced a settlement in a False Claims Act (FCA) qui tam case involving allegations of Medicare and Medicaid fraud. The defendants, a plastic surgeon based in California, his son, affiliated medical practices, and a billing company, have agreed to pay $23.9 million to resolve the claims. The settlement follows accusations made by the government and the relators that the defendants engaged in fraudulent practices, including falsifying the place of service for skin grafts and billing multiple times for single-use skin substitute products.

According to the allegations, the defendants purposely misrepresented the location where skin grafts took place to increase reimbursements from Medicare and Medicaid. Additionally, it was claimed that the plastic surgeon utilized unused portions of single-use skin graft materials in subsequent procedures for beneficiaries of these government healthcare programs, resulting in double billing.

According to prolific whistleblower lawyer and former FBI Special Agent Jason T. Brown, “This settlement represents a significant victory in the fight against healthcare fraud. The defendants in this case allegedly engaged in deceptive practices, exploiting the Medicare and Medicaid systems for their financial gain. The successful resolution of this qui tam lawsuit not only holds them accountable but also sends a strong message”.

The relators in this case were former employees of the plastic surgeon, his medical practices, and associated businesses.  Under the False Claims Act provisions they were entitled to up to $7.2 million in whistleblower rewards. The civil actions were filed under the names United States ex rel. TDP RCM Servs., LLC v. Aronowitz, et al. (C.D. Cal.), United States ex rel. Morris, et al. v. Tower Wound Care Ctr. of Santa Monica, Inc., et al. (C.D. Cal.), and United States ex rel. Bautista et al. v. Tower Outpatient Surgery Center, Inc. et al. (C.D. Cal.).