Case: 3:19-cv-00269-DMB-JMV Doc #: 1 Filed: 12/03/19 1 of 8 PageID #: 1

IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF MISSISSIPPI
OXFORD DIVISION

UNITED STATES OF AMERICA PLAINTIFF

v. 3:19-CV-269-DMB-JMV
CIVIL ACTION NO.: _______________
JURY TRIAL DEMANDED

CHRISTOPHER J. CUMMINS DEFENDANT

COMPLAINT
Pursuant to the False Claims Act, 31 U.S.C. § 3729, et seq. (“FCA”), the United States of

America brings this civil action against the Defendant for violations of the FCA and supplemental

claims for payment by mistake and unjust enrichment, as follows:

JURISDICTION AND VENUE

1. The United States of America brings this action under the Act to recover treble damages

and civil penalties arising out of Dr. Christopher J. Cummins’ submission of fraudulent claims for

medical services to the United States Government through the Medicare Program – or causing

their submission.

2. Under § 3732 of the Act, this Court has exclusive jurisdiction over actions brought under

the Act and supplemental jurisdiction under 28 U.S.C. § 1367 over claims arising from the subject

transactions. Jurisdiction is also conferred under 28 U.S.C. § 1331 as this civil action arises under

the laws of the United States.

3. Venue is proper in this district under 28 U.S.C. § 1391(b) and 3732(a) of the FCA as

Dr. Cummins resides and conducted business in, and the subject transactions took place in, this

judicial district – specifically the Oxford Division.

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PARTIES

4. Plaintiff, United States of America, funds certain medical care for eligible citizens

through Medicare and other agencies and programs acting through the Centers for Medicare and

Medicaid Services (“CMS”).

5. Defendant, Christopher J. Cummins, M.D., (“Cummins”) is a physician who, at all times

relevant, was the physician and owner of Magnolia State Family Medicine, LLC, in Ripley, Tippah

County, Mississippi, providing family medical care and related medical services for Medicare

patients, as well as obtaining and sharing monetary reimbursements from Medicare. Cummins is

believed to be a current resident of Lafayette County, Mississippi.

6. From January 19, 2010 through 2017, Dr. Cummins, with the aid and assistance of his

employees or contractors, knowingly submitted false claims to the Government through the

Medicare Program in violation of the False Claims Act by: (a) failing to properly document

medical services; (b) creating false and/or misleading medical records; (c) seeking payment for

services not rendered; (d) assisting, submitting and/or certifying claims containing false or

misleading information and that he knew did not comport with Medicare rules and regulations.

MEDICARE PROGRAM - PART B

7. At all relevant times, Dr. Cummins received a significant portion of his income from the

United States Government through the Medicare Program. The amount of the funds received is

governed under regulations promulgated by CMS.

8. To participate in the Medicare Program, any Provider – e.g. a physician or a non-

physician practitioner (“NPP”) – must first enroll in the Medicare Program, submit the required

Medicare Enrollment Application Form CMS-855I (“CMS Application”), and be approved as an

authorized Provider by CMS.

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9. In order to receive Medicare funds, enrolled providers, including Dr. Cummins,

together with their authorized agents, employees, and contractors, are required to abide by all of

the provisions of the Social Security Act, the regulations promulgated under the Act, and all

applicable policies and procedures issued by states.

10. Reimbursement for Medicare Part B claims is made by the United States through

CMS. CMS contracts with private agencies, usually insurance companies, called Medicare

Carriers (“Carriers”) to administer Part B of the Medicare program. See 42 U.S.C. §1395h.

Separate payments are made for each CPT procedural code listed on the Medicare Part B claims.

11. Among the rules and regulations which enrolled providers, including Dr. Cummins,

agreed to follow: (a) bill Medicare for only those covered services which are medically

necessary; (b) not bill Medicare for any services or items which were not performed or delivered

in accordance with all applicable policies, nor submit false or inaccurate information relating to

provider costs or services; (c) not engage in any act or omission that constitutes or results in

overutilization of services; (d) be fully licensed or certified to perform the services provided to

recipients; (e) comply with all applicable statutes, policies, and regulations applicable to

Medicare; (f) not engage in any illegal activities related to the furnishing of services to

recipients.

12. Providers who submit health care claims to Medicare (or one of its contracted carriers)

are required to understand and fully abide by Medicare regulations and bylaws, and certify that

each claim is true, correct and complete. A provider’s electronic signature certifies that the

services were proper, medically indicated and necessary for the health of the patient and

personally furnished by the provider, and complies with the Application and Medicare’s rules

and regulatory requirements.

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13. Medicare requires providers to use numeric codes (CPT codes) and specific diagnosis

codes (ICD codes).

14. Medicare provides reimbursement for the administration of viscosupplementation

agents through CPT Code 20610. The viscosupplementation agents such as Hyalgan and Supartz

are billed under HCPCS code J7321. Only FDA-approved viscosupplements may legally be

provided to patients.

15. A certified claim for payment submitted to Medicare for services, which the Provider

knows, or should know, was not supplied in compliance with Medicare’s rules and regulations,

constitutes a false claim under the False Claims Act.

16. All of the conduct alleged in this Complaint is alleged to have occurred “knowingly”

or with reckless disregard, as those terms are defined in the False Claims Act, 31 U.S.C. § 3729

and related case law.

FACTUAL ALLEGATIONS

17. Dr. Cummins provided a medical device to patients the he represented to be

Hyalgan (and/or Supartz).

18. Hyalgan (sodium hyaluronate) is a viscosupplementation agent manufactured

solely by the drug manufacturing company FidiaPharma USA. Hyalgan is used by

medical providers, including Dr. Cummins, for the treatment of osteoarthritis of the knee.

It is a characterized as an injectable Class III medical device and governed and approved

by the Federal Drug Administration (“FDA”). There is no generic or compounded

viscosupplementation agent that has been approved by the FDA for sale or use in the

United States or that is approved for reimbursement by any of the Federal Health

Programs.

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19. Only FDA-approved Hyalgan may be provided legally to patients. If the product is

not FDA approved, it is not legal, and it is not a proper viscosupplementation agent and is not

properly reimbursable by the Federal Health Programs, including but not limited to Medicare.

20. Dr. Cummins injected unknowing patients with a non-FDA approved substance under

the guise that it was Hyalgan and fraudulently billed the United States government for Hyalgan.

The non-FDA approved substance actually used on his patients is not properly reimbursable

under the insurance guidelines of Medicare.

21. Upon information and belief, Dr. Cummins purchased what can only be referred to as

“compounded” Hyalgan or “generic” hyaluronic acid derivatives purchased from a compounding

pharmacy in the State of Arkansas. For purposes of this Complaint the government will refer to

the non-FDA approved substance used as “compounded Hyalgan.”

22. Compounded drugs are not manufactured and so are not subject to FDA control,

regulations and protections. It is not possible to know what is actually being purchased, and such

products are subject to tampering, dilution, modification, spoliation, and other changes which

can make them harmful to patients and thus non-reimbursable by Medicare. Likewise, non-

name-branded intra-articular hyaluronic acid derivatives have not been subjected to the rigors of

FDA-approval and should not be used for government payor/Medicare patients.

23. Since at least 2010, Dr. Cummins unlawfully submitted or caused to be submitted

hundreds of false claims to Medicare for the use of the “compounded Hyalgan” using J-code

J7321, a code that is uniquely reserved for FDA-approved Hyalgan/Supartz. At no time did Dr.

Cummins advise any of his patients that any of these injections were not FDA-regulated

Hyalgan.

24. Because Dr. Cummins only used non-FDA-approved compounded Hyalgan, upon

information and belief, each and every claim submitted to Medicare from 2010 through 2017

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was a false claim under the Act. In order to obtain Medicare payments, the actions

perpetrated by Dr. Cummins were willing, intentional and fraudulent. Had the United

States/Medicare been aware that Dr. Cummins used non-named brand, non-FDA-

approved compounded Hyalgan, it would not have paid Dr. Cummins or his clinic for

such claims.

25. This unlawful activity by Dr. Cummins resulted in a fraud being perpetrated on

the federal Government, as it was billed for and paid for a product not properly

reimbursable in an amount of approximately $83,586.95, and Cummins put patients at

potential and grievous physical harm by being exposed to a non-regulated injectable

device.

The United States realleges and incorporates paragraphs 1 through 25 of this Complaint

as fully set forth herein in all Counts listed below:

COUNT I
False Claims Act – Presentation of False Claims

1. Dr. Cummins, through his own acts and through his various agents and/or

employees, knowingly presented or caused to be presented to an agency, officer, or

employee of the United States false or fraudulent claims for payment in violation of 31

U.S.C. § 3729(a)(1).

2. The United States, unaware of the foregoing circumstances and conduct of Dr.

Cummins, made full payments, which resulted in its being damaged in an amount to be

determined.

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COUNT II
False Claims Act – False Statements

1. Dr. Cummins, through his own acts and through his various agents and/or employees,

knowingly made, used, or caused to be made or used, false records or statements to get a false or

fraudulent claim paid or approved by the Government in violation of 31 U.S.C. § 3729(a)(2).

2. The United States, unaware of the foregoing circumstances and conduct of Dr.

Cummins, made full payments, which resulted in its being damaged in an amount to be determined.

COUNT III
False Claims Act – Possession of the Government’s Money

1. Dr. Cummins, through his own acts and through his various agents and/or employees,

knowingly had the possession, custody, or control of the property or money used, or to be used by

the Government and intended to defraud the Government in violation of 31 U.S.C. § 3729(a)(4).

2. The United States, unaware of the foregoing circumstances and conduct of Dr.

Cummins, made full payments, which resulted in its being damaged in an amount to be determined.

COUNT IV
Unjust Enrichment

1. This is an action to recover monies by which Dr. Cummins has been unjustly enriched.

Due to Dr. Cummins’ improper practice, the United States paid him monies he was not entitled to.

2. By reason of its payments, the United States is entitled to damages in an amount to be

determined by the jury.

PRAYER FOR RELIEF AND JURY DEMAND

WHEREFORE, PREMISES CONSIDERED, Plaintiff United States of America prays that the

Court enter judgment against Christopher Joseph Cummins and grant the following relief:

a. That the United States be awarded damages in the amount of three times the

damages sustained by the United States because of the false claims and fraud

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alleged within this Complaint, as the Civil False Claims Act, 31 U.S.C. § 3729 et

seq. provides;

b. That civil penalties of $5,500 to $11,000 be imposed for each and every false

claim that Dr. Cummins presented or caused to be presented to the United States,

or such other amount of penalties in effect at the time of each violation and/or

false claim;

c. That pre-and post-judgment interest be awarded, along with costs and expenses

necessarily incurred in bringing and pressing this case;

d. That Dr. Cummins be ordered to repay all sums wrongfully obtained or paid and

that this Court award such other and further relief as it deems proper.

The United States further demands a trial by jury of all issues so triable pursuant to Fed.

Rule Civ. P. 38.

Respectfully submitted this 3rd day of December, 2019.

William C. Lamar
United States Attorney
Northern District of Mississippi

By: /s/ J. Harland Webster______________

J. Harland Webster - MS BAR #102458
Assistant United States Attorney
Northern District of Mississippi
Ethridge Professional Building
900 Jefferson Avenue
Oxford, MS 38655-3608
Telephone: (662) 234-3351
E-Mail: joseph.webster@usdoj.gov

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