A Clay County doctor has been ordered to pay $180,000 in damages to Mountain State Blue Cross Blue Shield after he allegedly billed the insurance company for blood tests and allergy injections he never provided to patients.
CHARLESTON, W.Va. - A Clay County doctor has been ordered to pay $180,000 in damages to Mountain State Blue Cross Blue Shield after he allegedly billed the insurance company for blood tests and allergy injections he never provided to patients.
Dr. Sharooz S. Jamie, who twice served as mayor of the town of Clay, also must pay Mountain State Blue Cross an additional $94,000 in interest accrued since the case began in 2003, Mountain State lawyer Fred Early said Thursday.
"Mountain State has an obligation to its members to seek repayment of verified overpayments, and it will use the courts if necessary," Early said. "In the case of Dr. Jamie, it was necessary."
Jamie denied any wrongdoing Thursday, calling the allegations "pure fabrication." He said Mountain State owes him $500,000.
"This is an injustice," he said. "There's no sense to it at all."
In court filings, Jamie blamed some of the billing irregularities on his office not having proper computer software to process Mountain State insurance claims and inadequate training for staff.
"My job is seeing the patient," Jamie said Thursday. "I have nothing to do with billing. I have no idea how they came up with these allegations against me."
Parkersburg-based Mountain State Blue Cross first started raising questions about suspect billing for blood test panels in 2003. Jamie was performing hundreds more blood tests than other rural doctors with similar family practices, Mountain State alleged in a lawsuit.
A company investigation revealed that multiple blood tests were being performed on the same patients on the same days. Jamie also submitted claims for blood draws and allergy injections that were never done, Mountain State alleged.
The insurance company reimbursed Jamie for the fraudulent tests, then later asked the doctor to return the overpayments. Jamie refused and severed his relationship with Mountain State, the company alleges.
Last month, Wood Circuit Judge J.D. Beane issued a summary judgment order, ruling that Mountain State was entitled to damages.
"With regard to the incorrect, inaccurate and wrongful billing practices alleged by [Mountain State], [Dr. Jamie] does not, and cannot dispute that he over billed [Mountain State] by submitting claims for services and procedures he did not perform," Beane wrote in his ruling.
CHARLESTON, W.Va. - A Clay County doctor has been ordered to pay $180,000 in damages to Mountain State Blue Cross Blue Shield after he allegedly billed the insurance company for blood tests and allergy injections he never provided to patients.
Dr. Sharooz S. Jamie, who twice served as mayor of the town of Clay, also must pay Mountain State Blue Cross an additional $94,000 in interest accrued since the case began in 2003, Mountain State lawyer Fred Early said Thursday.
"Mountain State has an obligation to its members to seek repayment of verified overpayments, and it will use the courts if necessary," Early said. "In the case of Dr. Jamie, it was necessary."
Jamie denied any wrongdoing Thursday, calling the allegations "pure fabrication." He said Mountain State owes him $500,000.
"This is an injustice," he said. "There's no sense to it at all."
In court filings, Jamie blamed some of the billing irregularities on his office not having proper computer software to process Mountain State insurance claims and inadequate training for staff.
"My job is seeing the patient," Jamie said Thursday. "I have nothing to do with billing. I have no idea how they came up with these allegations against me."
Parkersburg-based Mountain State Blue Cross first started raising questions about suspect billing for blood test panels in 2003. Jamie was performing hundreds more blood tests than other rural doctors with similar family practices, Mountain State alleged in a lawsuit.
A company investigation revealed that multiple blood tests were being performed on the same patients on the same days. Jamie also submitted claims for blood draws and allergy injections that were never done, Mountain State alleged.
The insurance company reimbursed Jamie for the fraudulent tests, then later asked the doctor to return the overpayments. Jamie refused and severed his relationship with Mountain State, the company alleges.
Last month, Wood Circuit Judge J.D. Beane issued a summary judgment order, ruling that Mountain State was entitled to damages.
"With regard to the incorrect, inaccurate and wrongful billing practices alleged by [Mountain State], [Dr. Jamie] does not, and cannot dispute that he over billed [Mountain State] by submitting claims for services and procedures he did not perform," Beane wrote in his ruling.
On Thursday, Jamie criticized Beane and other Wood County judges who previously ruled for Mountain State.
"They're biased in Wood County against me," Jamie said. "It's pure discrimination."
Early said it was unfortunate that Mountain State had to go to court to recover "wrongfully obtained" overpayments to Jamie. The physician "knowingly and fraudulently" billed the company, according to the lawsuit.
"Doctors who are paid for wrongful claims hurt all of our members," Early said. "While we would prefer not to litigate, this case has proven we can succeed if forced to go to court."
In 2004, Jamie filed a counterclaim against Mountain State, denying the allegations and alleging that the insurance company defamed him and fraudulently withheld payments.
Two years later, a circuit judge dismissed the counterclaim, and Jamie appealed to the state Supreme Court, which sent the case back to Wood County.
Jamie expects to appeal Beane's latest ruling again to the Supreme Court.
He said Mountain State reimburses doctors for medical services at unfairly low rates.
"This is a big corporation, and I'm just a country doctor," said Jamie, who has worked in Clay County for 33 years. "They want to teach doctors not to raise their voice. I raised my voice, and now they want to shut me up."
In 2007, a U.S. Tax Court judge found that Jamie underreported his federal income taxes from 2000 to 2002. Jamie, who worked as a securities day trader as well as a physician at the time, was ordered to pay $163,372 in penalties.
Reach Eric Eyre at erice...@wvgazette.com
or 304-348-4869.
Post a comment
Justice surely is blind, when Professionals who steal money, commit Mail Fraud, etc. get fined, and young men without money go to Prison.