Missoula Surgeon Pays $3.7M to Settle Healthcare Fraud Allegations
The vascular surgeon will pay $3.7M to settle healthcare fraud allegations involving medically unnecessary surgeries and submitting false claims.
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By - David Bellamah, MD, a vascular surgeon in Missoula and Kalispell of Montana, reached a civil settlement and has agreed to pay the federal government $3.7 million to settle healthcare fraud claims.
According to the Department of Justice, the vascular surgeon allegedly violated the False Claims Act by performing medically unnecessary surgeries based on improper techniques and then submitted fraudulent bills to federal healthcare programs.
The False Claims Act states that it is illegal for companies to deliberately submit fraudulent claims for payment by federal healthcare programs such as Medicare or Medicaid.
“This civil settlement resolves claims of using improper techniques and unnecessary medical procedures to create and submit false claims to four federal health care programs. Submitting false claims for unnecessary procedures increases the cost of providing services to people who really need it,” US Attorney Leif M. Johnson said in a public statement.
“Had the United States known the truth, it would not have paid such claims. We will investigate and hold accountable medical providers who try to enrich themselves through false billing to federal health benefit programs.”
The court document states that the US’s claims against Bellamah and his practice arose from the company billing for services that were medically unnecessary and based on false medical records from January 1, 2015, through March 31, 2017.
Bellamah and the staff at Bellamah Vein Center allegedly used improper techniques to perform ultrasounds on patients.
Additionally, the company proceeded to use the false ultrasound findings to bill government-funded programs including Medicare, Medicaid, TRICARE, and the CHAMPVA program for medically unnecessary services related to the false diagnosis and treatment of venous reflux disease and varicose veins.
Lenore Lezanne, a former employee at Bellamah Vein Center, filed a suit against Bellamah Vein and Surgery in 2018, stating Bellamah received government funds for performing unnecessary venous procedures based on inaccurate medical records.
“Performing medically unnecessary surgeries risks the health and wellbeing of patients, compromises the integrity of federal health care programs, and increases the financial burden on taxpayers,” Curt L. Muller, Special Agent in Charge with the Department of Health and Human Services, Office of Inspector General said in a public statement.
“Working closely with our partners, HHS-OIG will continue to safeguard the integrity of federal health care programs by investigating individuals who seek to exploit them.”
The settlement was agreed upon by the US Attorney’s Office for the District of Montana, the Department of Health and Human Services Office of Inspector General, the Defense Health Agency, the Department of Veterans Affairs, and Lenore Lezanne.
The terms require Bellamah and his company to pay a settlement amount of $3,746,324 to resolve the civil complaint alleging violations of the False Claims Act and other common law claims.
“If the settlement amount is paid in full within 21 days of the effective date of the Settlement Agreement, no interest shall be charged. Otherwise, Bellamah shall make payments, plus interest, over five years. Upon receiving the settlement amounts, the United States will pay Lezanne 17 percent of each payment as her share of the settlement,” the District Attorney’s Office of Montana states.
In addition, Bellamah’s agreement to pay the settlement is not an admission of guilt by Bellamah.
Bellamah Vein Center issued a statement via its spokesperson on Facebook regarding the settlement.
"...a recent out of court settlement was reached by Bellamah Vein Center which is related to a federal insurance billing issue which is now resolved," Michael Paul, Bellamah's spokesperson, wrote. "The excellent patient care Bellamah Vein Center provides its many vein patients for years was never in question. In fact, the federal insurance billing allegations were never proven in a court of law and the settlement was agreed upon to avoid additional years of very expensive, legal fees. The settlement allows Bellamah Vein Center to quickly get back to the excellent patient care it provides its many patients, versus waiting for a conclusion many years from now."
Updated 12/21/2021: This article has been updated to include a statement from Bellamah Vein Center.
