PHILADELPHIA, PA — The United States has launched a civil lawsuit against Nueva Vida Multicultural/Multilingual Behavioral Health, Inc., and its principal, Dr. Ghodrat Pirooz Sholevar, accusing them of defrauding Medicaid through billing for non-existent psychiatric services. U.S. Attorney Jacqueline C. Romero announced the complaint on Monday, marking a significant step in the federal government’s efforts to combat healthcare fraud.
According to the complaint, Nueva Vida, which offered psychiatry and therapy services to economically disadvantaged adults and children in Philadelphia, is accused of billing Medicaid for thousands of psychiatric medication management appointments, or “med checks,” that did not occur as represented. These med checks are critical appointments where a psychiatrist assesses the impact of prescribed medications on patients. However, the lawsuit alleges that from 2009 to 2017, Dr. Sholevar billed Medicaid for extensive med checks without spending the requisite time with patients, if at all.
“This civil complaint underscores our commitment to pursuing those who exploit Medicaid, betraying the trust of vulnerable populations reliant on comprehensive mental health services,” stated U.S. Attorney Romero.
The lawsuit further claims that on numerous occasions, Nueva Vida billed Medicaid for more than 84 full-length med checks by Sholevar in a single day, which would necessitate over 21 hours of continuous appointments. It also accuses the defendants of billing for services when patients were hospitalized elsewhere and could not have received care from Nueva Vida.
Maureen Dixon, Special Agent in Charge of the Philadelphia Regional Office for the U.S. Department of Health and Human Services, Office of Inspector General, emphasized the importance of civil enforcement in maintaining the integrity of federal health programs.
The federal complaint also alleges that Nueva Vida was essentially an extension of Sholevar himself, allowing him to amass millions in compensation, significantly above the median income for child psychiatrists in the area. This lawsuit seeks damages and civil penalties for the fraudulent claims submitted to Medicaid.
The case came to light following audits by Community Behavioral Health, revealing consistent discrepancies and errors in Nueva Vida’s billing. The organization was ultimately removed from the Medicaid program in 2017.
While the lawsuit presents only allegations at this stage, with no liability determined, it represents a critical moment in the ongoing fight against healthcare fraud. Assistant U.S. Attorneys Erin E. Lindgren and Gregory B. in den Berken, along with healthcare fraud auditor George Niedzwicki, are leading the legal charge.
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