In a nearly 700-paragraph FCA complaint, DOJ alleges that Dr. Thomas Prose and his General Medicine family of companies defrauded Medicare over nearly a decade by submitting millions of dollars in claims for allegedly unperformed, unnecessary, or upcoded nursing home services. On one level, the suit is notable simply as evidence of DOJ’s continuing focus on alleged fraud involving nursing facilities, which picked up steam during the Trump Administration and has continued under President Biden. But what most caught our attention is that Prose himself has been a relator in multiple prior FCA matters relating to his work in the long-term care space, including in a case in which the Seventh Circuit recently reversed the dismissal of Prose’s allegations in a split decision featured on this blog. Prose also previously received more than $900,000 in a settlement of another FCA suit.
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