Medicare Compliance & Reimbursement

See what’s on the DOJ’s hitlist.

Authorities pushed full-steam ahead in January despite a raging pandemic. In fact, the month’s enforcement shows that the feds intend to hold physicians accountable for Medicare fraud schemes in 2021.

In Tennessee: Three Nashville-based providers settled False Claims Act (FCA) violations for fraudulent acupuncture claims. James P. Anderson, MD, owner of Affiliated Neurologists, PLC, Charles F. Spencer, DC, owner of Total Family Physicians Center PLLC d/b/a Total Family Health & Wellness and Mitchell P. Shea, DC, owner of Chiro2Med of Tennessee P.C. agreed to pay $1.72 million to “resolve liability under the False Claims Act for the alleged improper billing for electro-acupuncture using a peri-auricular stimulation device known as ‘P-Stim,’” a Department of Justice (DOJ) release said.

Between May 2016 and November 2018, the three practitioners billed Medicare and TennCare for the acupuncture devices using HCPCS code L8679 (Implantable neurostimulator, pulse generator, any type) — but the providers didn’t surgically implant neurostimulators, DOJ noted. The P-Stim devices the providers attached to patients’ ears with adhesive are not reimbursed by Medicare or TennCare.

In Florida: Even death won’t stop the DOJ from settling FCA liabilities. The estate of deceased Orlando, Florida-based urologist Patrick T. Hunter agreed to resolve FCA violations for medically unnecessary kidney stone procedures, a DOJ brief indicated.

For six years, “Dr. Hunter performed lithotripsy procedures on Medicare and TRICARE patients that were medically unnecessary because the procedures were not medically indicated or because there were no kidney stones in those patients,” said the DOJ release. His estate will pay $1.75 million to settle the liability.

“Physicians that perform illegal and baseless procedures violate the sanctity of the doctor-patient relationship,” warned U.S. Attorney Chapa Lopez in the release.

In New Jersey: Dr. Bernard Ogon in Burlington County, New Jersey will spend 33 months in prison and will pay $24 million in restitution for a telemedicine scam used to prescribe compounded medications.

“Ogon admitted he signed prescriptions for compounded medications (medications with ingredients of a drug tailored to the needs of a particular patient) without having established a doctor-patient relationship, spoken to the patient or conducted any medical evaluation,” a DOJ brief noted. Additionally, he signed preprinted prescription forms, was paid for signing, and returned prescriptions to pharmacies in on the conspiracy, costing healthcare programs millions.