CHARLESTON — Bali Plastic Surgery is asking Kanawha Circuit Judge Carrie Webster to dismiss a lawsuit filed by the West Virginia Department of Health and Human Resources alleging Medicaid fraud.
Bali argues that due to the ambiguous and vague nature of the allegations, the defendant wants the court to dismiss the complaint for failure to state a claim upon which relief can be granted.
Bali contends that the complaint is deficient of deeper factual allegations.
"Furthermore, plaintiff's pleadings also fail to demonstrate ascertainable damage caused by the alleged fraud," the motion states. "Plaintiff alleged a total of $448,417.50 in overpayments but failed to allege particular occurrences and misrepresentations that amount to the alleged total. Plaintiff's complaint is insufficient to factual allegations as to what damages, if any, have occurred, including how the plaintiff has calculated the alleged overpayments."
Bali is represented by Ben Salango and Christian Huffman of Salango Law in Charleston.
DHHR claims in its complaint that between Feb. 1, 2018, and April 20, 2020, the defendants submitted claims for payment to the state Medicaid program that were fraudulent because they billed for providing care under the Health Homes Program, but failed to perform the required patient evaluations and failed to create and/or submit documentation sufficient to support the billings, including failing to complete initial patient assessments.
DHHR claims the defendant failed to maintain the necessary records to fully demonstrate the extent, nature and medical necessity of services and items provided to individuals enrolled in the state's Medicaid program. It claims the defendant received a total of $448,417.50 in overpayments as a result of the wrongful acts and omissions.
DHHR claims Bali owes treble damages in the amount of $1,345,252.50. It is represented by Assistant Attorneys General Michael Myers and Jason D. Nicholas of the Medicaid Fraud Control Unit in Charleston.
Kanawha Circuit Court case number: 23-C-242
