Dr. Ghodrat Pirooz Sholevar and his company, Nueva Vida Multicultural/Multilingual Behavioral Health, Inc., have agreed to pay $900,000 to resolve allegations of Medicaid fraud. The settlement addresses claims that the defendants submitted false bills for medication management appointments that were too short to meet Medicaid’s regulations, resulting in improper payments for services not fully provided.
Nueva Vida, which operated three mental health clinics in Northeast Philadelphia, provided psychiatric services under Medicaid to both adults and children. Among the services offered were medication management appointments, which are required to be at least 15 minutes long in order to be reimbursed by Medicaid. These appointments involve reviewing a patient’s medical history, monitoring medication effectiveness, and adjusting prescriptions as needed.
However, according to the amended complaint filed by the U.S. Department of Justice, from January 2009 through March 2017, the defendants regularly billed Medicaid for appointments that were substantially shorter than 15 minutes. Furthermore, they overbilled by claiming more medication management appointments than could reasonably be conducted in a single day. The complaint also alleges that Sholevar falsified patient records, documenting overlapping appointment times that made it appear as if patients were seen for the required duration.
The government contends that the defendants knowingly disregarded Medicaid’s rules about appointment lengths and billing practices, despite being informed about the issue as early as 2004. Despite audits and notifications from Medicaid administrators, Nueva Vida continued the practice of submitting false claims until the company ceased operations in 2018.
U.S. Attorney Jacqueline C. Romero emphasized the impact of the fraudulent billing on vulnerable patients. “These individuals deserved full and appropriate health care services,” she stated, highlighting the potential harm caused by improperly managed psychiatric medications.
The settlement resolves a lawsuit filed under the False Claims Act, which seeks to prevent fraud in healthcare programs. Maureen R. Dixon, Special Agent in Charge for the Department of Health and Human Services Office of the Inspector General (HHS-OIG), called the actions of the defendants a violation of patients’ trust, leading to potential harm.
This case was investigated by the U.S. Department of Health and Human Services Office of Inspector General. Assistant U.S. Attorneys Erin Lindgren and Gregory in den Berken handled the prosecution.
“Medicaid provides important mental health services to adults and children,” said Maureen R. Dixon, Special Agent in Charge for the Department of Health and Human Services Office of the Inspector General (HHS-OIG). “The defendants’ actions defrauded the Medicaid program and may have resulted in patients not receiving the full services they deserve. HHS-OIG will continue to work with our partners at the United States Attorney’s Office to investigate allegations of Medicaid fraud and ensure proper services are provided to patients.”
