Attorney General Rokita and Team Win $700,000 Settlement over Alleged Medicaid Fraud by Hammond Orthopedic Surgeon

Wednesday, March 6, 2024 at 9:08 AM

Attorney General Todd Rokita Friday announced a $700,000 settlement on behalf of Hoosiers to address allegations that a Hammond orthopedic surgeon overbilled Indiana’s Medicaid program.

“The purpose of Medicaid is to help patients in need cover health care expenses they otherwise would find difficult to pay,” Attorney General Rokita said. “The program is not intended to serve as a cash cow for providers.”

An investigation by Attorney General Rokita’s Medicaid Fraud Control Unit uncovered abnormalities in charges billed to Medicaid by the Southeastern Medical Center (SEMC), operated by Dr. Kishan Chand.

Between Jan. 1, 2016, and June 1, 2021, SEMC submitted approximately 13,101 claims indicating that medical staff performed spinal manipulation on patients who were under anesthesia.

Records, however, showed no associated billing for an anesthesiologist or a hospital or surgical center and that the frequency of billing by SEMC was a substantial outlier across all Medicaid providers — all of which raised the question of whether manipulation under anesthesia had been performed at all.

“Physicians and other providers have an ethical and legal obligation to accurately report medical procedures for which they seek Medicaid reimbursement,” Attorney General Rokita said. “My office will continue to ensure citizens’ tax dollars are protected from fraud and abuse by vigorously pursuing providers who have been unjustly enriched through improper billing.”

The Indiana Medicaid Fraud Control Unit receives 75 percent of its funding from the U.S. Department of Health and Human Services under a federal grant. The remaining 25 percent is funded by the State of Indiana.

Article provided by IN Attorney General's Office