U.S. Attorney Reclaims $275k in Medicare Payments from Dermatologist Ordering Unnecessary Tests

Hines Dermatology Associates, Inc., a Massachusetts based corporation with a practice and laboratory in Providence, R.I., is reimbursing $275,000 to the Medicare Program after the U.S. Department of Health and Human Services (HHS) and U.S Attorney’s Office in Rhode Island determined that unnecessary pathology services were being performed at the Rhode Island office and then billed to the federal government.

Dr. Yvonne C. Hines, M.D., president and medical director of Hines Dermatology Associates, Inc., and Dermatopath Lab, was also required to enter into an Integrity Agreement with HHS to ensure compliance with regulations, directives and programs associated with Medicare, Medicaid, and all other federal health care programs.

The civil settlement requiring the reimbursement of funds and implementation of an Integrity Agreement was announced by U.S. Attorney Peter F. Neronha and Susan Waddell, Special Agent in Charge of the regional office of the U.S. Department of Health and Human Services, Office of Inspector General.

Between mid February 2004 and early October 2007, through the practice, Dr. Hines and the lab falsely represented that some patient test results required additional and more expensive testing and thus were eligible for reimbursement by Medicare, when in fact, they were not necessary.

U.S. Attorney Peter F. Neronha commented, “Health care fraud victimizes nearly every American – whether covered by Medicare, Medicaid, or one of the many private insurers. It has rapidly become one of our most urgent, destructive and widespread national challenges; a crime for which we will have zero tolerance. Cases like this will be rooted out and those responsible will be held accountable.”

“Charging Medicare for unnecessary medical services is a crime and those that do so will be brought to justice,” said Special Agent in Charge Susan Waddell, of the Federal Department of Health and Human Services Office of Inspector General (HHS-OIG) Boston Region. “The HHS-OIG integrity agreement will monitor future activity to eliminate fraudulent billing for tests that were never needed.”

The case was handled by Assistant U.S. Attorney Dulce Donovan and John W. O’Brien, Senior Counsel, Office of the Inspector General (OIG), U.S. Department of Health and Human Services. The matter was investigated by Special Agent George E. Walford, III, OIG-HHS, Boston.

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