The federal government is suing general medicine

EAST STREET. LOUIS – The federal government filed in the U.S. District Court for the Southern District of Illinois against General Medicine, PC; its owner, Dr. Thomas M. Prose and 17 related corporate entities owned by Prose.

In a 96-page complaint, the government alleges that Prose and his companies violated the False Claims Act as part of an extensive health care fraud scheme involving the submission of thousands of false claims to the Medicare program. Since 2016, Medicare has paid defendants more than $40 million.

General Medicine and the other Prose-owned corporate defendants are based in Novi, Michigan. He reportedly employed doctors and nurse practitioners to treat patients in nursing homes and assisted living facilities in numerous states, including Illinois and Missouri.

The government alleges that Prose and his companies knowingly billed Medicare for visits with residents of the facility that were not medically necessary, did not meet billing code requirements, or were not performed at all. As alleged in the complaint, these visits were the result of GP directing its physicians and nurse practitioners to meet visit quotas and to perform numerous patient visits and assessments each month regardless of whether patients had need the services.

They also allegedly submitted inflated claims to Medicare using billing codes for complex, full visits when providers spent little time with patients. On several occasions, the defendants allegedly filled out progress notes containing inaccurate information or embellished parts of the notes to bill visits using codes with higher reimbursement rates.

“Vulnerable patients living in nursing homes and assisted living facilities should receive medical care based on their medical needs, not unnecessary visits fabricated to meet artificial corporate quotas,” said U.S. Attorney Steven D. Weinhoeft. “Charging Medicare for unnecessary and worthless services at inflated rates drains valuable taxpayer funding from the program and ultimately hurts the patients who need it most. We will continue to work closely with our law enforcement partners to ensure that federally funded healthcare programs are not abused.


The investigation was a collaborative effort between the U.S. Attorney’s Office for the Southern District of Illinois, the U.S. Department of Health and Human Services – Office of Inspector General, the Medicaid Fraud Enforcement Unit Illinois State Police, Federal Bureau of Investigation, U.S. Department of Labor – Office of Inspector General, U.S. Department of Labor – Benefits Security Administration, Inspectorate Service United States Postal Office and the Office of the Inspector General of the Department of Defense.

The investigation has already resulted in former general practice nurse practitioner Jami Mayhew pleading guilty to healthcare fraud and the indictment of Phillip Greene, a former general practice doctor, in September 2021.

The United States is represented in civil litigation by United States Assistant Attorneys Nathan Wyatt and Laura Barke. The case is captioned United States v. General Medicine, PC, et al., No. 22-cv-00651-SMY (SD Ill.). The allegations made in the complaint are only allegations and no liability has been determined.

Members of the public who believe they may have information related to this program or any similar scheme involving healthcare fraud in nursing homes are encouraged to contact law enforcement by calling the hotline HHS OIG Fraud Hotline at 1-800-HHS-TIPS (1-800-447-8477) or by going online to https://oig.hhs.gov/fraud/report-fraud/.

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