Whistleblower Represented by Simon Law Firm Gets Portion of Settlement from U.S. Government

Case Summary

Simon Law’s client, a former employee of Progressive Pain Management in Festus, filed a False Claims Act whistleblower lawsuit against her former employer, Dr. Nehal Modh, and his company, alleging Medicare and Missouri Medicaid fraud. The U.S. Attorney’s Office Eastern District of Missouri announced a $1.2 million settlement, with Tony Simon’s client receiving approximately $180,000 as her whistleblower share.

Key Highlights

• The case was brought under the False Claims Act, which allows whistleblowers to receive a portion of any government settlement resulting from their disclosures.
• Modh and his company allegedly billed for ultrasound guidance that was not actually used during certain pain management injections, submitted false claims for facet joint injections that did not meet billing requirements, and improperly coded claims to obtain excess reimbursement.
• U.S. Attorney Sayler A. Fleming publicly acknowledged the courage of Simon Law’s client in coming forward as part of the Eastern District of Missouri’s civil enforcement efforts.

Case Analysis

The case illustrates the mechanics of False Claims Act whistleblower litigation, where an insider’s firsthand knowledge of billing practices becomes the basis for a government fraud investigation. Simon Law’s client targeted specific allegations, including provable billing discrepancies, claims for services not actually rendered and claims that failed to meet documented billing requirements. The involvement of both the U.S. Attorney’s Office and Missouri Medicaid points to coordinated federal-state enforcement, reflecting how Medicare and Medicaid fraud claims are often pursued jointly when a provider bills both programs improperly.

Outcome/Impact

The case reinforces the role whistleblowers play in surfacing healthcare billing fraud that might otherwise go undetected.