PORTLAND, Maine: United States Attorney Darcie N. McElwee today announced that Jamie P. Loggins, M.D. has agreed to pay $629,056.76 to settle allegations that he violated the federal False Claims Act (the “FCA”). The civil settlement agreement resolves allegations that Loggins prescribed orthotic braces that were not medically necessary to individuals with whom he had no valid prescriber-patient relationship.
Medicare statutes, regulations and guidelines make clear that participating providers may only bill for services actually provided and which are medically reasonable and necessary. As alleged by the Government, from September 2018 through November 2022, Loggins caused claims to be submitted to Medicare for payment for medical services that were not reasonably medically necessary or for which medical necessity could not be determined. More specifically, the Government alleges that Loggins worked with a telemedicine company to provide telemedicine consultations and consultation services. As part of those services, Loggins would review prepared intake forms, which included purported complaint information for a beneficiary and prepared prescriptions for orthotic braces. Frequently, the intake forms included multiple complaints and prescriptions for orthotic braces for each individual beneficiary. The Government alleges that Dr. Loggins would then electronically sign these prescriptions, despite there being no valid prescriber-patient relationship and no medical necessity for the claims.
The FCA provides that any person who “knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval” or “knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim” is liable to the United States for three times the amount of damages which the United States sustains, plus a civil penalty for each FCA violation. The Government alleges that by submitting claims for payment for medical services that were not medically reasonable or necessary, Loggins violated the FCA.
Loggins cooperated with this investigation and did not admit liability in the settlement agreement. Federal authorities encourage health care providers to cooperate with investigations involving the possible submission of false claims to federal programs. Entities or individuals that make proactive, timely and voluntary self-disclosures to the U.S. Attorney’s Office may receive credit during the resolution of a later FCA case.
The U.S. Department of Health and Human Services, Office of Inspector General investigated the case.
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