BANGOR, Maine — A local board-certified gynecologist who operates three medical facilities for women’s health has agreed to pay almost $300,000 to settle a federal complaint over improper billing of Medicare and MaineCare.
Robert A. Grover, D.O., the owner of Bangor Women’s HealthCare, the Maine Center for Continence and Pelvic Disorders, and the Laser Vaginal Rejuvenation Institute, has agreed to pay $296,492 to settle federal complaints for improper Medicare and MaineCare billing, U.S. Attorney Thomas E. Delahanty II announced Wednesday.
In the summer of 2009, Dr. Grover and his businesses informed the U.S. Department of Health and Human Services, Office of Inspector General through the Office of Inspector General’s Self-Disclosure Protocol program, that there were problems in their billings to the Medicare and MaineCare programs, according to a press release. The problems included overbilling in excess of allowable amounts for various gynecological services and billing for services that were never performed.
“As far as this case is concerned, the settlement achieves a just and appropriate result given the facts and circumstance leading to the false billing and Dr. Grover’s self disclosure and cooperation throughout,” Assistant U.S. Attorney Michelle Giard Draeger said.
Self-reporting mistakes and violations can permit individuals and businesses to avoid enhanced monetary penalties under certain circumstances. In a separate criminal action brought in 2011, a former employee of BWH pleaded guilty to fraud charges and was sentenced to more than three years in prison related to the false billings.
The complaint stemmed from the health care fraud committed by a woman who worked at Bangor Women’s HealthCare from June 2006 to January 2009 and was solely responsible for billing in 2008.
Dawn Zehrung admitted to submitting fake bills to public and private insurance companies and naming herself as a patient for services she did not receive. The practice was overpaid by Anthem Blue Cross Blue Shield, MaineCare and Medicare by more than $300,000. She was given a prison sentence of three years and one month in August 2011, and ordered to pay $355,000 in restitution.
After an investigation by the U.S. Attorney’s Office, U.S. Department of Health and Human Services and the Maine attorney general’s office — with which Dr. Grover and BWH cooperated throughout — the U.S. and the state of Maine filed a civil complaint against Dr. Grover and BWH alleging they violated the federal False Claims Act from January 2008 through January 2009. The violations came from improperly billing Medicare and MaineCare. The complaint sought monetary damages and the settlement amount represents the full amount of monies received by Dr. Grover and BWH from the false claims.