Plantation Physician and Physician Practice to Pay $750,000 to Resolve False Claims Act Allegations Involving Medically Unnecessary Sinus and Throat Procedures

     Dr. Paul B. Tartell, an ENT physician practicing in Plantation, Florida and his practice Paul B. Tartell, M.D., P.L., have agreed to pay $750,000 to resolve allegations that he violated the False Claims Act by billing for surgical endoscopies with debridement and laryngeal stroboscopies that were not provided or not medically necessary.

     Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, Shimon R. Richmond, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), George L. Piro, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office, and Scott Rezendes, Special Agent in Charge, U.S. Office of Personnel Management, Office of Inspector General (OPM-OIG), made the announcement today.

     “We remain deeply committed to holding individual health care providers accountable for exploiting federal health care programs,” said Wifredo A. Ferrer, United States Attorney for the Southern District of Florida. “Physicians who bill for unnecessary services and services that were never provided put their own desire for personal profit ahead of their oath to provide safe and essential patient care. Doctors engaged in this conduct violate their patients’ trust and deprive federal health care programs of resources intended to provide care for the elderly, sick, and impoverished.”

The settlement announced today resolves allegations originally brought by Theodore Duay, a former patient of Dr. Tartell. Mr. Duay filed a complaint under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties to sue on behalf of the government and receive a share of any recovery. The False Claims Act authorizes the United States to intervene in such lawsuits and take over primary responsibility for litigation. Mr. Duay will receive $135,000.

Mr. Duay alleged that Dr. Tartell routinely performs diagnostic endoscopies on patients but bills these diagnostic procedures as more expensive and intrusive surgical debridements. Surgical debridements are a specialized procedure frequently performed following sinus surgery involving the transnasal insertion of an endoscope and parallel insertion of various instruments to remove postsurgical crusting, bone or tissue deposits. It may also be used to remove crusts and debris in patients with longstanding chronic sinusitis who have undergone surgery in the past.

In addition to the allegations regarding surgical debridements, the settlement also resolves the United States’ allegations that Dr. Tartell systematically billed federal health benefit programs, in particular, Medicare and the Federal Employment Health Benefits Program, for claims arising from laryngeal video stroboscopies that were not performed or were not medically necessary.

“When physicians and their practices bill for services not provided or not medically necessary it undermines the public’s trust in medical institutions and the financial integrity of federal health care programs,” said Shimon R. Richmond, Special Agent in Charge, U.S. Department of Health and Human Services Office of Inspector General. “Our agents and lawyers will aggressively pursue those who exploit taxpayers, patients, and government health programs.”

“This case demonstrates the FBI’s commitment to use all legal means available, including the False Claims Act, to pursue individuals who compromise the federal health care system for their own profit,” said George L. Piro, Special Agent in Charge, FBI Miami. “The FBI and our law enforcement partners are committed to investigating fraud schemes that divert taxpayer dollars away from those in need of care.”

“Today’s settlement is a reminder that fraud against the Federal Employees Health Benefits Program will not be tolerated,” said OPM Special Agent in Charge Rezendes. “I would like to thank the OPM OIG criminal investigators and our law enforcement partners for their fine work in protecting not only the health and wellbeing of FEHBP enrollees, but also the financial integrity of the program.”

The investigation of Dr. Tartell reflects a coordinated effort among the U.S. Attorney’s Office for the Southern District of Florida, the Department of Health and Human Services’ Office of Inspector General, the Federal Bureau of Investigation, and the United States Office of Personnel Management Office of the Inspector General along with the Florida Blue Special Investigative Unit. The investigation and settlement were handled by Assistant United States Attorney Jessica E. Elliott.

The case is captioned United States ex rel. Duay v. Paul B. Tartell, M.D. et al., No. 14-23954-Civ-Altonaga (S.D. Fla.). The claims settled by the lawsuit are allegations only and there has been no determination of liability.

Related court documents and information may be found on the website of the District Court for the Southern District of Florida at www.flsd.uscourts.gov or on http://pacer.flsd.uscourts.gov.