PHILADELPHIA, PA — Dr. Ghodrat Pirooz Sholevar and his company, Nueva Vida Multicultural/Multilingual Behavioral Health, Inc., have agreed to pay $900,000 to settle allegations of Medicaid fraud. The U.S. Attorney’s Office announced that the settlement addresses claims that the defendants submitted false billing for medication management appointments that were shorter than required.
The alleged misconduct, which spanned from January 15, 2009, to March 31, 2017, involved fraudulent claims for appointments that did not meet Medicaid’s 15-minute minimum for full reimbursement. According to the government, Sholevar and Nueva Vida falsely recorded appointment times and billed for overlapping sessions, occasionally claiming to have seen multiple patients simultaneously at different clinic locations. Despite prior audits and warnings about these issues dating back to 2004, the defendants allegedly persisted in these practices.
“The defendants allegedly overbilled the Medicaid program at the expense of low-income Philadelphians, including children, who were seeking mental health services,” said U.S. Attorney Jacqueline C. Romero. “These individuals deserved full and appropriate health care services, including careful management of psychiatric drugs that can have dangerous side effects. We will hold accountable those who bill Medicaid but fail to provide the full service, because this not only defrauds the government, but deprives vulnerable individuals of care.”
Nueva Vida operated three mental health clinics in Northeast Philadelphia, providing psychiatry services to Medicaid patients. Medication management appointments, key to assessing and adjusting psychiatric treatments, must be documented with specific time entries as a condition for Medicaid reimbursement. The government alleges that the defendants knowingly disregarded these requirements over the years.
“Medicaid provides important mental health services to adults and children,” said Maureen R. Dixon, Special Agent in Charge for the Department of Health and Human Services Office of the Inspector General (HHS-OIG). “The defendants’ actions defrauded the Medicaid program and may have resulted in patients not receiving the full services they deserve. HHS-OIG will continue to work with our partners at the United States Attorney’s Office to investigate allegations of Medicaid fraud and ensure proper services are provided to patients.”
This agreement resolves allegations brought under the False Claims Act. While the settlement does not determine liability, the case underscores the government’s commitment to addressing healthcare fraud. The investigation was handled by the Department of Health and Human Services Office of Inspector General and the U.S. Attorney’s Office, specifically Assistant U.S. Attorneys Erin Lindgren and Gregory in den Berken, along with auditor George Niedzwicki.
The clinics ceased operations in 2018. The allegations resolved in this settlement are claims only, with no admission of wrongdoing.
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