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Lawsuit Accuses Dallas Doctors of "Drive-By Billing" and Other Systemic Medicare Fraud

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Update at 4:24 p.m.: I still haven't heard directly from TVA, but a press release from them just hit the wires. Mills' claims are "ridiculous," and she was fired for "ongoing inappropriate and abusive conduct toward her supervisor and fellow employees." The full release is after the jump.

Original post:: Two years ago, Cortez Mills was hired by Texas Vascular Associates, a network of nine physicians and a half dozen clinics in Dallas and suburbs, to work in their medical office, where she had the sisyphean task of trying to wrangle reimbursement from Medicare and insurance companies.

It didn't take long for Mills to notice that something was off. The doctors, she says, would routinely "upcode" procedures to get more money from Medicare. They would bill Medicaid patients for the difference between the federal reimbursement rate and what they charge private patients for a procedure, which is illegal. They often did "drive-by billing," charging for seeing patients while they were actually just in the room while another doctor did the work.

One of the physicians, Dr. Brad Grimsley, would, according to Mills, submit exaggerated Medicare claims when he felt he had done more work than the government would pay for.

Mills, having just received coding certification two years before, says she refused when she was asked to submit false claims. That's illegal, she told them. You aren't allowed to do that. To which the doctors replied, Like hell we aren't, cursed at and threatened Mills, then had another employee do it. They eventually fired her, which prompted the wrongful termination lawsuit she filed yesterday.

The doctors tried to coerce her into performing illegal acts, then fired her for refusing to do so, it claims. Furthermore, their conduct was "extreme and outrageous and totally intolerable in a civilized society" and caused Mills a good deal of emotional distress.

"Ms. Mills identified what we believe was an illegal scheme at TVA, and she lost her job for refusing to play along," Mills' attorney, Matt Scott, said in a press release distributed yesterday. "She had the courage to speak up and recognize this was wrong."

I called TVA yesterday afternoon and left a voicemail with the office manager seeking comment. Nothing yet. In the meantime, if you're into lengthy descriptions of arcane medical coding procedures, you can read the lawsuit for yourself.

TVA's response:

Texas Vascular Associates, PA, the premier vascular surgical group in the state of Texas, will aggressively fight false charges from a former employee who has accused the group and its doctors of Medicare and insurance fraud. Cortez Mills, who worked for Texas Vascular for two years before being terminated for cause, filed a lawsuit on July 26, 2012.

"The allegations are outrageous and completely false, and we look forward to proving that in court. We have not committed any illegal acts or Medicare fraud," said Dr. Bertram Smith, president of Texas Vascular Associates, PA. "Ms. Mills is a disgruntled former employee who was terminated for cause. She was not fired because she uncovered fraudulent billing practices at our offices. She was fired because of ongoing inappropriate and abusive conduct toward her supervisor and fellow employees."

Ms. Mills was denied unemployment benefits in a decision upheld in June 2012 by the Texas Workforce Commission because she had been terminated for just cause. The Texas Workforce Commission found that Ms. Mills had been warned several times that the abusive manner with which she treated other employees was unacceptable.

"The allegations have no basis in the facts or the law. Terminated employees often try to justify their own personal failings or otherwise grind an ax at the courthouse or in the media. Here, Ms. Mills has doubled down with a legal filing and a media blitz. Neither effort will succeed," said Thomas Melsheimer, a principal in the Dallas office of Fish & Richardson who is representing Texas Vascular along with Fish principal Steve Stodghill.

Mr. Melsheimer, who was an Assistant U.S. Attorney for the Northern District of Texas from 1990 to 1993, recently obtained a record-setting $158 million settlement from Johnson & Johnson and its Janssen division - the largest Medicaid fraud recovery in Texas history - in conjunction with the Texas Attorney General Greg Abbott. Mr. Melsheimer brought the qui tam lawsuit on behalf of a whistleblower.

It's important to note that Ms. Mills is not a whistleblower and this is not a health care fraud case. Ms. Mills has two limited employment claims, the factual basis of which has been rejected twice by the Texas Workforce Commission. In legitimate cases of wrongdoing, the law provides a method for fraud cases to be reported and investigated confidentially.

"Ms. Mills didn't choose a legitimate route to report her ridiculous allegations of fraud for good reason - her claims are bogus. She seeks personal gain and attention through a public lawsuit and is using the media in an attempt to tarnish her former employer," added Mr. Melsheimer. "Texas Vascular will unequivocally defend its good name within the Dallas medical community and among the thousands of patients it has successfully treated over the years. When this is over, we expect our client to be completely vindicated of all charges."

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