A Michigan plastic surgeon is facing a whistleblower lawsuit alleging he submitted false claims to Medicarefor years.

The U.S. government filed the whistleblower lawsuit under the False Claims Act against Dr. Adam B. Smith, M.D. and Borealis Plastic Surgery, PLLC. The whistleblower provision of the False Claims Act allows a citizen to file a lawsuit on behalf of the government and the government can join as a plaintiff.

Dr. Smith is a medical doctor and plastic surgeon who practiced plastic surgery in Michigan from 2011 through 2014. He was the only member and physician at Borealis during those years.

According to court documents, when Dr. Smith began practicing in June 2011, he had staff privileges at Munson Medical Center.  Munson Medical is a 442-bed hospital facility serving the northern Michigan area.

In December 2012, Munson Medical began a review of Dr. Smith’s patient charts as part of the proctoring process, which is an objective evaluation of a doctor’s competence.

The Munson review purportedly revealed a number of documentation issues, including incorrect coding and claims that fractures not identified in radiology imaging were treated by Dr. Smith. One reviewer allegedly noted “egregious” concerns, and another reviewer mentioned it was possible Dr. Smith was committing fraud.

Those findings prompted Munson Medical to start a more formal review process of Dr. Smith’s practices. The external medical review in May 2013 found problems with all of the patient cases reviewed. Dr. Smith allegedly reported fractures that never existed, claimed he performed treatment of non-existent fractures and he lacked evidence of nerve repair operations he claimed he had performed.

As a result of these findings, Munson suspended Dr. Smith’s craniofacial surgery privileges in its facility for 30 days in July 2013.

Medicare Fraud Allegations

After submitting supportive reviews of himself completed by a doctor who had mentored him during residency, Dr. Smith was reinstated at Munson, the whistleblower lawsuit claims.

Munson again reviewed Dr. Smith’s records and found problems in 12 out of the 14 cases inspected. The reviewer allegedly suspected fraudulent activity, including the possibility Dr. Smith was submitting false claims to Medicare. These issues came to light in January 2014.

Among the cases that made reviewers question that Dr. Smith could have been making false claims to Medicare, the following were included:

• Patient W. C. was an 89-year-old Medicare patient who had incurred facial fractures upon falling. The review concluded one of Dr. Smith’s operations was unnecessary and that an operation he claimed he performed on March 9, 2013 to implant hardware allegedly never occurred. A post-surgical x-ray showed no evidence of implants in the man’s face. Even though W.C. died from respiratory complications just days after surgery, Dr. Smith received payment for the claimed surgeries because W.C. was insured by Medicare.
• Medicaid patient R.H. received care for a gunshot wound. Dr. Smith allegedly described fractures that didn’t exist and subsequently claimed he repaired the nonexistent fractures during an operation completed July 30, 2012. Reviewers allege Dr. Smith’s additional claims that he repaired nerve lacerations also were false because the nerves “likely were not injured and did not need repair.

Dr. Smith resigned his privileges with Munson on Jan. 27, 2014, but in his resignation letter, he reportedly asked Munson not to report his resignation to the National Practitioner Data or to the State of Michigan’s Bureau of Health Care Services. Munson refused those conditions.

The federal government’s investigation into Dr. Smith’s claims found that of claims submitted between 2011 and 2012, he allegedly sent in 72 false Medicare claims and 17 false Medicaid claims.

The government alleges Dr. Smith’s false claims to Medicare cost the program at least $58,452, while the false claims to Michigan’s Medicaid program cost at least $5,925.

The Medicare Fraud Lawsuit is United States of America v. Adam B. Smith, M.D. and Borealis Plastic Surgery, PLLC, Case No. 1:18-cv-1445, in the U.S. District Court for the Western District of Michigan, Southern Division.