Metro Atlanta Arthritis Specialist Settles False Medicare Claims Case for $2.18 Million

Georgia Medical Practice Pays $2.18 Million to Settle Unlicensed Infusion Claims

A metro Atlanta medical practice and its physician owner have agreed to pay $2.18 million to resolve allegations that they violated federal law by allowing unlicensed medical assistants to administer powerful chemotherapy drugs to patients.

The settlement resolves claims against Arthritis & Rheumatology Center, P.C. and Dr. Jatin Patel following an investigation that began with a whistleblower complaint from a former employee. The whistleblower, Phillips Allender, will receive $414,200 from the settlement amount.

Federal investigators alleged that the rheumatology practice used unlicensed medical assistants to perform infusions of potent chemotherapy medications—a practice that violates Georgia state law. Since Medicare regulations prohibit payment for services delivered in violation of state licensing requirements, the claims submitted to the federal healthcare program allegedly violated the False Claims Act.

“Physicians who disregard state and federal law by allowing unqualified individuals to perform unauthorized medical services place patients in needless danger,” said U.S. Attorney Theodore S. Hertzberg for the Northern District of Georgia. “Our office will hold accountable those who participate in federal healthcare programs but seek to enrich themselves by not following the rules.”

The settlement highlights ongoing concerns about proper administration of specialty medications in outpatient settings. Infusion therapy for rheumatologic conditions typically involves complex biological agents that require specific training and expertise to administer safely. Proper credentialing of medical staff who administer these medications is crucial for patient safety, as improper administration can lead to serious adverse reactions or reduced therapeutic effectiveness.

Healthcare compliance experts note that this case serves as an important reminder to medical practices about the legal requirements for administering infusion therapies. Under Georgia state regulations, only properly licensed medical professionals with specific training may administer intravenous medications, particularly those classified as chemotherapy agents.

The case also underscores the significant role whistleblowers play in exposing healthcare fraud. The False Claims Act allows private citizens with knowledge of fraud against government programs to file lawsuits on behalf of the government and share in any recovery. These “qui tam” provisions have become a powerful tool in combating healthcare fraud nationwide.

Despite agreeing to the substantial settlement, neither Patel nor the Arthritis & Rheumatology Center admitted liability for the allegations. The U.S. Attorney’s Office confirmed that the settlement resolves the claims without a determination of liability.

This settlement comes amid increased scrutiny of specialty medical practices that offer in-office infusion services. Such services have become an important revenue stream for many rheumatology and other specialty practices, but they also bring additional regulatory requirements and oversight.

The case was handled by the U.S. Attorney’s Office for the Northern District of Georgia, working in conjunction with federal healthcare fraud investigators. The civil settlement resolves a lawsuit that was filed in U.S. District Court.

Healthcare compliance attorneys recommend that medical practices regularly audit their infusion services to ensure all staff members administering medications are properly licensed and operating within their scope of practice. Additionally, practices should maintain robust documentation of staff qualifications and training to demonstrate compliance with state licensing laws.

For patients receiving infusion therapies for rheumatologic conditions, healthcare advocates suggest asking about the qualifications of staff members administering treatments and being aware of their rights to receive care from properly licensed medical professionals.