$1.5 MILLION JUDGMENT ENTERED AGAINST FORMER ALVA DOCTOR

Oklahoma City, Oklahoma – John C. Richter, United States Attorney for the Western District of Oklahoma, announced that a $1,500,000 civil fraud consent judgment was entered today against Gregory Pinegar, formerly a general practice physician in Alva, Oklahoma, for defrauding Medicare. In April of this year, Pinegar was convicted of defrauding Medicare in a parallel criminal proceeding and is now serving a 33-month prison term at a federal penitentiary in Beaumont, Texas.

Summary of the Cases

The civil case originated with a complaint filed under the False Claims Act and alleged that Pinegar, who operated a medical practice in Alva, overbilled Medicare for the administration of certain drugs. During an investigation by the Office of Inspector General for the Department of Health and Human Services, the FBI, and the U.S. Attorney’s Office, a criminal case was also opened.

It was alleged that from 2000 to 2005, Pinegar defrauded Medicare for two prescription medications: Procrit and Remicade.

Procrit is administered by injection and stimulates production of red blood cells. It is prescribed for anemia conditions, including those suffered by cancer patients in chemotherapy, HIV-positive patients in drug-therapy regimes, and by kidney disease patients undergoing dialysis. Between January 2000 and May 2005, Pinegar’s practice billed Medicare for 19.75 million units of Procrit but ordered no more than 7.4 million units from suppliers.

Remicade is administered by intravenous infusions and is used to treat rheumatoid arthritis, Crohn’s disease (chronic inflammation of the gastrointestinal (GI) tract), ulcerative colitis, and other diseases of the GI tract. From January 2003 to May 2005, Pinegar’s practice billed Medicare for 112,110 milligrams of Remicade but ordered no more than 49,600 milligrams from suppliers.

The civil case alleged that before sending billing information to Medicare, Pinegar altered billing forms to show either that his office had administered drugs that were not actually administered or that his office had administered the drugs in quantities greater than what were actually administered. In the criminal case, Pinegar entered a guilty plea in which he acknowledged that to defraud Medicare he falsified information in his patients’ medical records and caused members of his staff to send false billing information.

Summary of the Judgments

In the criminal case, Pinegar was sentenced to 33 months in prison and ordered to pay $473,881.55 in restitution to Medicare and $69,685.26 in restitution to BlueCross BlueShield of Oklahoma. The civil case was concluded today with the entry of the $1,500,000 civil fraud consent judgment which is in addition to, and separate from, the restitution and prison term ordered in the criminal case.

As a condition of his guilty plea in the criminal case, Pinegar has surrendered his medical license. In the event that Pinegar’s medical license is later restored, the Department of Health and Human Services has instituted administrative proceedings to exclude him from the being able to bill the Medicare program in the future.

These cases were the result of an investigation conducted by the FBI and the Office of the Inspector General for the Department of Health and Human Services. Assistant U.S. Attorneys Scott E. Williams and David L. Walling prosecuted the criminal case. Assistant U.S. Attorneys Robert Troester, Tom Majors, and Don Evans represented the United States in the civil proceedings.

$1.5 MILLION JUDGMENT ENTERED AGAINST FORMER ALVA DOCTOR Oklahoma City, Oklahoma – John C. Richter, United States Attorney for the Western District of Oklahoma, announced that a $1,500,000 civil fraud consent judgment was entered today against Gregory Pinegar, formerly a general practice physician in Alva, Oklahoma, for defrauding Medicare. In April of this year, Pinegar was convicted of defrauding Medicare in a parallel criminal proceeding and is now serving a 33-month prison term at a federal penitentiary in Beaumont, Texas. Summary of the Cases The civil case originated with a complaint filed under the False Claims Act and alleged that Pinegar, who operated a medical practice in Alva, overbilled Medicare for the administration of certain drugs. During an investigation by the Office of Inspector General for the Department of Health and Human Services, the FBI, and the U.S. Attorney’s Office, a criminal case was also opened. It was alleged that from 2000 to 2005, Pinegar defrauded Medicare for two prescription medications: Procrit and Remicade. Procrit is administered by injection and stimulates production of red blood cells. It is prescribed for anemia conditions, including those suffered by cancer patients in chemotherapy, HIV-positive patients in drug-therapy regimes, and by kidney disease patients undergoing dialysis. Between January 2000 and May 2005, Pinegar’s practice billed Medicare for 19.75 million units of Procrit but ordered no more than 7.4 million units from suppliers. Remicade is administered by intravenous infusions and is used to treat rheumatoid arthritis, Crohn’s disease (chronic inflammation of the gastrointestinal (GI) tract), ulcerative colitis, and other diseases of the GI tract. From January 2003 to May 2005, Pinegar’s practice billed Medicare for 112,110 milligrams of Remicade but ordered no more than 49,600 milligrams from suppliers. The civil case alleged that before sending billing information to Medicare, Pinegar altered billing forms to show either that his office had administered drugs that were not actually administered or that his office had administered the drugs in quantities greater than what were actually administered. In the criminal case, Pinegar entered a guilty plea in which he acknowledged that to defraud Medicare he falsified information in his patients’ medical records and caused members of his staff to send false billing information. Summary of the Judgments In the criminal case, Pinegar was sentenced to 33 months in prison and ordered to pay $473,881.55 in restitution to Medicare and $69,685.26 in restitution to BlueCross BlueShield of Oklahoma. The civil case was concluded today with the entry of the $1,500,000 civil fraud consent judgment which is in addition to, and separate from, the restitution and prison term ordered in the criminal case. As a condition of his guilty plea in the criminal case, Pinegar has surrendered his medical license. In the event that Pinegar’s medical license is later restored, the Department of Health and Human Services has instituted administrative proceedings to exclude him from the being able to bill the Medicare program in the future. These cases were the result of an investigation conducted by the FBI and the Office of the Inspector General for the Department of Health and Human Services. Assistant U.S. Attorneys Scott E. Williams and David L. Walling prosecuted the criminal case. Assistant U.S. Attorneys Robert Troester, Tom Majors, and Don Evans represented the United States in the civil proceedings.
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