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November 29, 2007

Alva doctor faces civil judgment

A $1.5 million civil fraud consent judgment was entered Thursday against a former Alva doctor now serving a 33-month federal prison sentence for Medicare fraud.

Gregory Pinegar was convicted in April of defrauding Medicare in a parallel criminal proceeding. He is in the federal penitentiary in Beaumont, Texas.

The civil case, according to John C. Richter, U.S. attorney for the Western District of Oklahoma, originated with a complaint filed under the False Claims Act that alleged Pinegar overbilled Medicare for the administration of certain drugs.

It was alleged from 2000 to 2005, Pinegar defrauded Medicare for two prescription medications: Procrit and Remicade.

Procrit is administered by injection and stimulates production of red blood cells. It is prescribed for anemia conditions, including those suffered by cancer patients in chemotherapy, HIV-positive patients in drug-therapy regimes and by kidney disease patients undergoing dialysis. Between January 2000 and May 2005, Pinegar’s practice billed Medicare for 19.75 million units of Procrit but ordered no more than 7.4 million units from suppliers.

Remicade is administered by intravenous infusions and is used to treat rheumatoid arthritis, Crohn’s disease, ulcerative colitis and other diseases of the gastrointestinal tract. From January 2003 to May 2005, Pinegar’s practice billed Medicare for 112,110 milligrams of Remicade but ordered no more than 49,600 milligrams from suppliers.

The civil case alleged before sending billing information to Medicare, Pinegar altered billing forms to show either his office had administered drugs that were not actually administered or his office had administered the drugs in quantities greater than what actually were administered, according to a release from Richter’s office.

In the criminal case, Pinegar also was ordered to pay $473,881.55 in restitution to Medicare and $69,685.26 in restitution to BlueCross BlueShield of Oklahoma.

The civil case that concluded Thursday is in addition to, and separate from, the restitution and prison term ordered in the criminal case.

As a condition of his guilty plea in the criminal case, Pinegar has surrendered his medical license. If his medical license is later restored, the Department of Health and Human Services has instituted administrative proceedings to exclude him from the being able to bill Medicare in the future.

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