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Orthopedic, anesthesia providers settle for $3.2 million

  • By Winston Skinner
  • |
  • Apr. 11, 2018 - 8:28 AM

A local orthopedic practice and anesthesia providers working with them have agreed to pay a total of $3.2 million to settle claims regarding Medicare payments.

Georgia Bone & Joint and Southern Bone & Joint have agreed to pay $1.6 million to the federal government. Southern Bone & Joint operates in Coweta County as Summit Orthopedic Surgery Center.

The remaining $1.6 will be paid by Southern Crescent Anesthesiology, PC or Sentry Anesthesia Management, LLC. The two do anesthesiology work for Southern Bone & Joint. David LaGuardia, a Certified Registered Nurse Anesthetist, has been a co-owner of the two anesthesiology companies and was a party to the agreement.

Also party to the agreement was Sharon Kopko, a former practice manager for Southern Bone & Joint. After she left employment with the the orthopaedic practice, Kopko filed a complaint – in 2013– with the U.S. District Court of the Northern District of Georgia.

Kopko’s complaint was a qui tam action, which allows a citizen to file a complaint and receive a portion of the settlement in a case.

Court papers show $1,453,927 of the settlement money is restitution paid to the federal government for charges made connected with the use of medication of Canadian origin. Kopko is to receive $256,000 from the settlement.

Southern Bone & Joint issued a statement that the practice agreed to settle in light of continued costs associated with the federal inquiry:

“The government has unlimited resources at their discretion while small corporations have limited resources. Unfortunately, a settlement was a necessity considering the cost of time and money to continue this litigation process of defending our position of innocence.”

The statement also noted the investigation “did not involve any patient or quality care concerns.”

“George Bone & Joint would like to, at this point, put this behind us and continue providing the best orthopedic care to this community as they have for the past 30-plus years,” Patty Attaway, practice manager, said Tuesday.

The federal inquiry centered on allegations that LaGuardia and his company provided a free medical director to Summit Surgery Center in order to induce it to choose to perform more procedures at the surgery center rather than in the GBJ office and that GBJ and LaGuardia caused the submission of false claims to Medicare for prescription drugs purchased outside of the United States and, therefore, not approved by the U.S. Food and Drug Administration.

“Kickbacks should never play a role in medical decision-making,” said U.S. Attorney Byung J. “BJay” Pak.  “It is critical to our health care system that patients seeking health care know that their providers’ recommendations are based on what is in the patient’s best interests and not influenced by illegal kickbacks or arrangements.”

“Decisions on where and how patients’ medical procedures are performed should never be made based on thinly veiled bribes, as was alleged in this matter,” said Derrick L. Jackson, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services. “Such alleged schemes will be aggressively investigated and prosecuted.”  

“Abuses of the health care system destroy the basic trust between providers and patients, between taxpayers and government,” said David J. LeValley, special agent in charge of FBI Atlanta.

“This settlement sends a clear message to all health care providers that fraudulent activities intended to defraud federal benefit programs are a federal crime that carries serious consequences and will not be tolerated,” said Imari Niles, special agent in charge with the U.S. Postal Service, Office of Inspector General.

“The claims resolved by the settlement are allegations only, and there has been no determination of liability,” according to a press release issue by Pak’s office.

“GBJ ad SBJ deny that any medical director services were provided to their clinic operations by the contracted anesthesiologists and contend that the quality assurance activities conducted by the anesthesiologists on their own services advance good patient care and are not a kickback of any kind,” according to the practice’s press statement.

The statement also noted the “contract for anesthesiology services has existed for many years and continues to this day.”

In the settlement, the federal government alleged that between Sept. 1, 2011 and Dec. 16, 2015, GBJ and LaGuardia submitted claims to Medicare for Hyalgan, a medication used for injections to ease joint pain. Because the Hyalgan came from Canada, it was not a permitted drug claim via Medicare.

Hyalgan is an appropriate treatment for joint pain and is available for legitimate purchase in the United States. It was the first drug approved for viscosupplement injections in 1997 by the FDA.

The case was investigated by the U.S. Attorney’s Office for the Northern District of Georgia, the U.S. Department of Health & Human Services Office of Inspector General, the FBI and the U.S. Postal Service Office of Inspector General. The civil settlement was reached by Assistant U.S. Attorneys Darcy Feuerzeig Coty and Neeli Ben-David.