United States Attorney Jacqueline C. Romero announced a settlement involving Dr. Ghodrat Pirooz Sholevar and his company, Nueva Vida Multicultural/Multilingual Behavioral Health, Inc., who have agreed to pay $900,000 to resolve allegations of fraudulent Medicaid billing. The allegations stated that the clinic billed for medication management appointments that were shorter than required by regulations.
Nueva Vida operated three mental health clinics in Northeast Philadelphia, providing psychiatry services under Medicaid to both adults and children. The government claimed that from January 15, 2009, through March 31, 2017, the clinic submitted false bills for these appointments because they did not meet the minimum length of 15 minutes necessary for full reimbursement.
The United States alleged that Sholevar recorded inaccurate start and end times for patient visits, suggesting patients were seen for the required duration when they were not. These records sometimes showed overlapping times where Sholevar was reportedly seeing multiple patients simultaneously at different locations.
Despite being informed as early as 2004 about issues with appointment durations and documentation, the defendants allegedly continued their practices. Nueva Vida stopped operating its clinics in 2018.
“The defendants allegedly overbilled the Medicaid program at the expense of low-income Philadelphians," said U.S. Attorney Romero. "We will hold accountable those who bill Medicaid but fail to provide the full service."
Maureen R. Dixon from the Department of Health and Human Services Office of Inspector General commented on the case: “The defendants’ actions defrauded the Medicaid program and may have resulted in patients not receiving the full services they deserve.”
This settlement resolves a lawsuit filed under the False Claims Act in U.S. District Court for Eastern Pennsylvania. The investigation was conducted by HHS-OIG and handled by Assistant United States Attorneys Erin Lindgren and Gregory in den Berken along with auditor George Niedzwicki.
The case is titled United States v. Nueva Vida Multicultural/Multilingual Behavioral Health, Inc., Civ. No. 24-1451 (E.D. Pa.). The claims resolved are allegations only without any determination of liability.