U.S. settles N.C. health care fraud case for $6.2 million

In the largest federal health care fraud settlement ever in North Carolina’s western district, Northcross Medical Center and its former owner, Dr. Mark Tuan Le, agreed on June 9 to pay the United States $6.2 million to settle a lawsuit alleging Medicare and Medicaid fraud.

The government’s complaint alleged that between Dec. 7, 2007 and March 31, 2013, Le submitted claims for payment to Medicare and Medicaid for procedures that weren’t entitled to reimbursement because they were medically unnecessary, never occurred, or were performed on immediate family members.

In the related criminal case, Le pleaded guilty June 25 to seven counts of health care fraud, one count of conspiracy to commit health care fraud, and one count of tax evasion. His sentencing date has not yet been set.

According to the complaint, Le ordered three medical diagnostic machines so he could perform unnecessary tests, and told his staff to require the tests in order to pay for the machines. To justify the tests, Le allegedly ordered his staff to include non-existent symptoms in patients’ medical records.

As an example of Le’s fraud, the complaint alleges he submitted bills to Medicare for reimbursement “for a hemorrhoid removal and skin tag removals for a patient who was in a coma in a hospital in a different part of the state on the day Dr. Le claims to have provided the services.”

U.S. Attorney Anne Tompkins could not be reached for an interview, but issued a written statement through her office’s press department.

“Dr. Le and his practice exploited Medicare and Medicaid, two very important programs that provide assistance to older and less fortunate North Carolinians,” Tompkins said. “This $6.2 million civil settlement against Dr. Le, the largest ever in the Western District against a single physician, serves as a reminder and warning to those who choose to defraud our health care system leaving taxpayers to pick up the tab.”

Follow Laurie Landsittel on Twitter @NCLWLandsittel