United States Attorney Bill Nettles announced Friday that the United States Attorney's Office settled claims of health care fraud with Dr. James Vest and his clinics.
Those clinics are Primary Medical in Surfside Beach, Carolina Forest Family Medicine, and Rivertown Primary Medical in Conway.
Prosecutors contended that Dr. Vest's practices submitted claims to Medicare and TRICARE for services that were provided by mid-level providers, nurse practitioners and physician assistants, as though the services were provided by Dr. Vest himself.
Both Medicare and TRICARE pay 85% of the physician fee schedules for services provided by mid-level providers.
The investigation began with the filing of a whistleblower lawsuit called a qui tam lawsuit under the False Claims Act.
The suit was filed by one of the nurse practitioners who worked in Dr. Vest's practices.
The False Claims Act allows individuals to file lawsuits with allegations that fraud has been committed against the federal government on behalf of the government.
Whistleblowers, referred to as Relators under the False Claims Act, are entitled to share in any recovery received by the government. In this case, Ms. Carey will receive 20% of the funds of the settlement or $65,000 plus her attorney fees.
"Health care fraud remains a high priority in this office. When a claim is submitted that misrepresents the service provided or who provides the services, it is false and we will make the case a priority," Judge Nettles said.
"Dr. Vest allegedly cheated taxpayers by overbilling government health plans for services his office provided," said Derrick Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services Office of Inspector General region covering South Carolina.
"Working with our Federal law enforcement partners, our investigators will unravel such schemes and bring suspects to justice."
