Pennsylvania Psychiatrist Pramod Pilania, Billed for 120 Patients a Day, Pays $91K False Claims Act Settlement

April 27, 2020

A psychiatrist at the Lehigh Valley Community Mental Health Centers who claimed he was able to see more than 120 patients in one day at Valley and Philadelphia clinics has reached a settlement with federal prosecutors.

Dr. Pramod Pilania said he was able to see that many patients and traveled between clinics at the Northeast Community Mental Health Centers in Philadelphia and the Lehigh Valley Community Mental Health Centers locations in Allentown, Bethlehem, and Reading, the U.S. Attorneys Office for the Eastern District of Pennsylvania said.

Pilania will now pay $91,109 under a settlement agreement to resolve potential liability under the False Claims Act.

“Dr. Pilania, who has never had any legal issues before, regrets his involvement in this case, but is proud that he cooperated with the government’s investigation in every way,” his attorney, Abraham Rein said. “He looks forward to moving on with his work during this difficult time.”

“The allegations against Dr. Pilania – that he billed federally funded healthcare programs for over 120 patients per day while also commuting between locations that are an hour’s driving distance apart – are egregious,” U.S. Attorney William McSwain said. “My office is committed to rooting out healthcare fraud and protecting the integrity of our Medicare and Medicaid systems by holding everyone involved accountable, including any providers who try to cheat those systems.”

Pilania, claimed to have seen more than 120 Medicaid patients, including children, in a single day, on six dates in 2010, according to a news release.

On each of the dates in question, Pilania said he travelled between the Northeast clinic in Philadelphia and the Lehigh Valley clinic in Allentown.

Federal authorities said under Medicaid time requirements, it was impossible Pilania saw that many patients in one day.

Medicaid administrators are required to have “medication management” or “med check” visits last at least 15 minutes long, and practitioners have to record the start and end times on patient encounter forms.

If Pilania saw 120 patients in one day, and stuck to the 15-minute requirement, it would have taken him 30 hours, authorities said.

According to the settlement agreement, Pilania did not see some of the 120-plus patients for 15 minutes on specific dates. The settlement alleges that Pilania did not record the beginning and ending times on patient encounter forms.

In 2015, the U.S. Attorneys Office filed a civil health care fraud lawsuit against Lehigh Valley Community Mental Health Centers and its principals, Melchor Martinez and Melissa Chlebowski.

At the time, the Northeast and Lehigh Valley clinics were the largest providers of mental health services to Medicaid patients in their respective regions.

The nine Pennsylvania clinics collected about $75 million in federal Medicare and state-and-federal Medicaid payments from 2009 through 2012, the suit states. The Lehigh Valley and Northeast clinics had several hundred employees and, as of 2012, more than 14,000 patients combined.

Authorities said Martinez was convicted in 2000 for billing psychotherapy services not rendered and falsification of records at Philadelphia clinics. As such, he was prohibited from participating in Medicaid, Medicare or any federally funded health care programs.

Melissa Chlebowski, Martinez’s wife and the clinics’ owner, was accused of presenting herself as the “public face” of the clinics, and obscuring her husband’s management of the clinics.

The suit was settled two years ago, and a $3 million consent judgment made against the defendants.

Source: “Lehigh Valley psychiatrist claimed he saw 120 patients in 1 day, feds say,” lehighvalleylive.com, April 22, 2020. URL: https://www.lehighvalleylive.com/lehigh-county/2020/04/lehigh-valley-psychiatrist-claimed-he-saw-120-patients-in-1-day-feds-say.html