U.S. Attorney reaches settlement with York County doctor
May 11—A retired family physician who had offices in Sanford and Biddeford has agreed to pay $330,607 to settle allegations that he violated the federal False Claims Act, the United States Attorney's Office for the District of Maine announced Thursday.
The civil settlement agreement reached this week between Gary S. Winn, the federal government and the state of Maine resolves allegations that Winn submitted false claims to federal Medicare and MaineCare (Maine's Medicaid program) from January 2014 through November 2017, Darcie N. McElwee, the U.S. Attorney for the District of Maine, said in a statement.
As a result of the settlement, a stipulation of dismissal was filed Thursday by the U.S. Attorney's Office and the Maine Office of the Attorney General. The case was investigated by the U.S. Attorney's Office, the Maine Attorney General's Office, the U.S. Department of Health & Human Services and the federal office of Inspector General.
On April 27, 2023, prosecutors filed a civil complaint against Winn in U.S. District Court in Portland alleging that he "knowingly submitted or caused to be submitted false claims for payment to the federal Medicare program and the state of Maine's MaineCare program for services that were not performed or were not reasonably medically necessary."
At the time of the violations more than six years ago, Winn, a doctor of osteopathic medicine, who lives in Arundel, owned and operated "Provider's Care" a family medical practice with offices in Biddeford and Sanford, according to court records.
Winn is represented by Portland attorney Michael Cunniff, who issued a statement Thursday night.
Cunniff said Winn, who retired in 2021, chose to settle the allegations to avoid the "delay, uncertainty, inconvenience and expense of protracted litigation of the government's allegations that certain Medicare and MaineCare reimbursement claims filed by Dr. Winn during the period spanning 2014 through 2017 were false in that they did not adequately document medical services or referred to medical services that were not performed or were not medically necessary."
"Prior to settling the matter, Dr. Winn disputed (and continues to dispute) through submissions to the government demonstrating that patient records adequately supported those claims," Cunniff said.
When Winn began his medical practice in 2007, he learned that many medical professionals in York County avoided taking welfare clients.
"Dr. Winn on the other hand, endeavored to be socially responsible, specifically choosing to provide health care services to those members of his community who were most in need of help, but least able to afford those services," Cunniff said. Winn's approach to medical care meant that a large segment of his patients received social services, including participation in government-funded health care insurance, Cunniff said.
McElwee said that under the False Claims Act and state statute, any person, who "knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval" can be held liable to the U.S. government for three times the amount of damages.
"As alleged in the complaint, by submitting claims for payment for medical services that were not provided or were not medically reasonable or necessary, Winn violated the FCA," McElwee said in her statement.
