Improper Billing of P-Stim Devices Leads to More Fraud Settlements
Two chiropractic practices agree to pay over $800,000 to resolve liability for the alleged improper billing of P-Stim devices.
In the latest case of improper billing of P-Stim electro-acupuncture devices, two integrated chiropractic practices and their owners have agreed to pay $805,978 to resolve liability under the False Claims Act. This case comes on the heels of several other similar enforcement actions within the past year in Texas, Tennessee, Pennsylvania, and Georgia, as the Department of Justice (DOJ) prioritizes this trend in billing fraud.
Discover Optimal Healthcare of Brookhaven, Pa., with its owner Jason Weigner and his affiliate Weigner Healthcare Management Group, LLC (collectively, “Weigner”) and Yucha Medical Pain Management & Chiropractic Rehabilitation, LLC of Pottstown, Pa., and its owners, Randolph E. Yucha and Rodney Gabel (collectively, “Yucha”), were discovered to have been improperly billing Medicare for the surgical implantation of neurostimulators — a procedure which usually requires an operating room and which is reimbursed by federal healthcare programs — when in fact they only performed nonsurgical applications of ANSiStim (a brand of P-Stim) through a non-surgeon contractor physician. The application of a P-Stim device is not surgery and should not be billed using surgical codes. ANSiStim devices are applied with an adhesive and insertion of a limited number of needles; their application does not involve surgery or anesthesia, nor does it take place in an operating room.
Medicare does not reimburse for acupuncture devices like P-Stim, which may have led some chiropractic practices to try to recoup monies they are not owed by fraudulently claiming P-Stim applications as surgical neurostimulator implantation procedures. Blatant fraud has been challenged in one case, however. A neurosurgery practice that was fined more than $1 million is consequently suing the marketers who allegedly pushed the practice to bill federal healthcare programs for the use of these devices. Regardless of the reason for the improper billing, the DOJ is not relying on whistleblowers to bring these incidents to light but actively pursuing their own enforcement priority.
Claiming HCPCS Level II Code L8679
The Centers for Medicare & Medicaid Services (CMS) posted an MLN Matters article on incorrect billing of HCPCS Level II code L8679 on Jan. 29, 2020, to address this issue. Per CMS, code L8679 Implantable neurostimulator, pulse generator, any type should only be reported with procedures that require surgical implantation into the central nervous system or targeted peripheral nerve. Electro-acupuncture devices (i.e., non-invasive devices that do not require surgical implantation and/or an incision) and implantable neurostimulators are two separate devices, and coding electro-acupuncture devices as implantable neurostimulators is incorrect. Review the article to find a list of appropriate procedures that must accompany claims that include code L8679.
As of March 1, 2020, claims for HCPCS Level II code L8679 must be billed with the same date of service as the applicable surgical procedure code. Claims for code L8679 reported with an appropriate surgical code will be suspended for medical review to verify that coverage, coding, and billing rules have been met. Claims submitted without an appropriate procedure code will be rejected.
Acting United States Attorney Jennifer Arbittier Williams commented, “Our continued enforcement through this series of cases has already recovered millions and is a lesson to anyone who might consider a similar fraudulent billing scheme – especially those that prey on vulnerable Medicare beneficiaries looking for legitimate pain management solutions. You will be held accountable by our Office and our partners at the Centers for Medicare & Medicaid Services’ Center for Program Integrity, the Department of Health and Human Services Office of Inspector General, other federal healthcare programs, state partners, and sister U.S. Attorney’s Offices around the country. And if you have already been involved in such a scheme, it is better to come forward and self-disclose than have us find you, as we will.”
Medical coders and billers should be aware of the correct use of code L8679 and CMS’ policies to avoid penalties for improper billing and reimbursement.
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