STEVEN MURPHY, M.D. and his practices, MURPHY MEDICAL ASSOCIATES, LLC and DIAGNOSTIC AND MEDICAL SPECIALISTS OF GREENWICH, LLC, located in Stamford, have entered into a civil settlement agreement with the federal and state governments in which they will pay $866,539 to settle allegations of COVID-19 related fraud and health care fraud. As part of the settlement, Murphy and his practices agreed to be excluded from all federal health care programs for a period of three years.

The government alleges that Murphy and his practices submitted false and fraudulent claims to the Health Resources Services Administration (HRSA), which is a sub-agency of the U.S. Department of Health and Human Services, to reimburse Murphy for "uninsured" patients treated during the COVID-19 pandemic. The government also alleges that Murphy submitted false claims to Medicaid and Medicare for blood testing "panels" allegedly performed by Murphy's in-house lab.

COVID-19 Uninsured Program Fraud

In response to the COVID-19 pandemic, Congress passed a series of bills to provide funds to health care providers for COVID-19 testing and treatment for uninsured individuals (the "Uninsured Program"). The Uninsured Program reimbursed eligible health care providers for COVID-19 testing, treatment, and vaccine administration provided to uninsured individuals. HRSA was selected to provide oversight and management of the Uninsured Program.

An uninsured individual was defined as someone who was "not enrolled" in a government or private health insurance program as of the date of service in question. Prior to seeking reimbursement from the Uninsured Program, health care providers were required to attest to the government that they had confirmed that the patients for whom they were seeking reimbursement were uninsured.

Murphy and his practices participated in the Uninsured Program, attested that the patients for whom they sought payment were uninsured, and received reimbursement from the Uninsured Program for those patients. The government alleges that Murphy and his practices had information, including copies of insurance cards and other documents, in their files indicating that certain patients for which they made attestations and submitted claims for reimbursement to the Uninsured Program were, in fact, enrolled in government or private health insurance programs. In addition, Murphy and his practices changed the patient's insurance identifying information to "Covid19 HRSA Uninsured" in their internal electronic medical records system and then submitted claims and received reimbursement from the Uninsured Program for those patients.

Blood Testing Fraud

Murphy had an in-house lab that performed blood tests on patients. The lab performed blood tests on patients who had possible exposure to COVID-19 or were presenting with COVID-19 symptoms, and also performed blood tests on non-COVID patients, including those who were having an annual physical exam.

Murphy and his practices utilized blood testing panels in their in-house lab. The blood testing panels were not billed and paid at one price per panel. Each blood test that made up the panel was billed separately to Medicare or Medicaid.

Reagents were used to run the specific blood tests that made up the panel, but there were times when Murphy and his practices failed to purchase certain reagents or otherwise did not have certain reagents, so they could not run the complete blood testing panel. The government alleges that Murphy and his practices billed Medicare and Medicaid for specific blood tests that were part of their standard panel, but which were never actually performed, because they did not have the reagents necessary to perform the specific blood tests that were billed.

To resolve the governments' federal and state False Claims Act allegations, Murphy and his practices have agreed to pay $866,539, which covers the time-period from September 2019 through April 2022. Murphy and his practices also agreed to be excluded from all federal health care programs for a period of three years.

This matter was investigated by the Office of Inspector General for the Department of Health and Human Services and the Federal Bureau of Investigation. The matter was handled by Assistant U.S. Attorney Richard M. Molot, with the assistance of Auditor Susan Spiegel, and by Deputy Associate Attorney General Gregory O'Connell of the Connecticut Office of the Attorney General.

People who suspect health care fraud are encouraged to report it by calling 1-800-HHS-TIPS or the Health Care Fraud Task Force at (203) 777-6311.