The U.S. Attorney’s Office for the Northern District of Texas filed a lawsuit March 22 against a dermatologist and his clinic alleging they violated the False Claims Act by submitting nearly $4.2 million in fraudulent claims to TRICARE.
The civil complaint alleges that in March 2015, Clay Cockerell, MD, 64, signed an agreement that allowed Progen, a laboratory management company, to use his Dallas clinic’s lab license to submit false claims for toxicology and pharmacogenomic tests that were not medically necessary. It also claims Progen agreed to pay Cockerell Dermatopathology 20 percent of the tests' net revenue.
In an attempt to eschew the Anti-Kickback Statute, the complaint claims Dr. Cockerell specified to Progen that Cockerell Dermatopathology would not provide any testing services to beneficiaries of federal health insurance programs. The complaint goes on to say he quickly became aware Progen was violating these terms and even received warnings that his clinic was violating the False Claims Act.
Progen was also offering $50 Walmart gift cards to persuade TRICARE beneficiaries to provide urine and saliva samples for testing that were expensive and medically unnecessary, according to the complaint.
The complaint alleges that after multiple patient complaints, Cockerell Dermatopathology sent TRICARE a retraction letter in January 2016 admitting it had received more than $900,000 for false claims, and Dr. Cockerell continued to let Progen submit lab claims to TRICARE using his clinic's license.
After a CBS News report report aired in June 2016 detailing the Walmart gift card scheme, Cockerell Dermatopathology sent another retraction letter to TRICARE admitting it had received an additional $3.2 million for false claims. The complaint alleges that the clinic said it would refund TRICARE for those improper claims but never did.
The complaint filed March 22 seeks to recover the nearly $4.2 million Dr. Cockerell and his practice allegedly accumulated via false claims.