Three Medical Groups And A Medical Billing Company Agree To Pay $3,340,979 To Resolve Investigation Into Medicare Overbilling Scheme
Baltimore, Maryland B Medical billing company Engage Medical, Inc., its owner Sanjay Puri and three medical practices that were its clients have agreed to pay a total of $3,340,979 to resolve claims that Engage Medical overbilled for nuclear stress tests. Engage Medical and Sanjay Puri have agreed to pay $544,500; Advanced Cardiology Center and its owners Pankaj Lal, M.D., Mubashar Choudry, M.D. and Moshin Ijaz, M.D. agreed to pay $1,894,549.50; Reva Gill, M.D. and Kenilworth Internists, P.A. agreed to pay $242,204; and Sureshkumar Muttath, M.D. agreed to pay $659,726.
The settlement was announced by United States Attorney for the District of Maryland Rod J. Rosenstein and Special Agent in Charge Nicholas DiGiulio, Office of Investigations, Office of Inspector General of the Department of Health and Human Services.
“When medical providers can enrich themselves at taxpayers’ expense by falsely representing that they provided expensive procedures, the government must be vigilant in pursuing fraudulent claims,” said U.S. Attorney Rod J. Rosenstein. “Anyone who knowingly reports false medical billing codes to induce the government to pay more money is lying, cheating and stealing.”
The allegations resolved in the settlement agreement involve overbilling of nuclear stress tests between July 31, 2007 and March 8, 2011. Engage Medical operated in Virginia, Washington, D.C. and Maryland. During this time, Engage Medical contracted with physicians and physician practices, holding itself out as having expertise in medical billing. Engage Medical staff would obtain records from physician clients related to the medical services provided, and transmit that information to staff in India, where medical coders would apply the relevant Current Procedural Terminology (“CPT”) codes and bill applicable insurance, including Medicare and other federally funded health insurance programs.
The billings at issue involved nuclear stress tests which are designed to assess cardiac function. Engage Medical marketed these tests to general practitioners, persuading them that instead of referring the patients to cardiologists for these tests, Engage could arrange to have the testing service performed in the general practitioner’s offices and bill for the tests, all of which would increase the general practitioners’ incomes. Dr. Muttath and Dr. Gill, two internists, agreed to allow Engage to provide this service.
Engage Medical’s billing of these tests, however, was false and in direct contradiction to published materials about such medical billing. Engage Medical systematically billed for each service twice, using a CPT code modifier intended to be used when the service had been repeated by the same physician or when a distinct service was performed on the same day. In fact, none of the tests were repeated and none of the tests was a distinct procedural service.
Engage Medical also included with its billing a CPT code that was intended to be used for interpreting and reporting images, even though proper CPT coding for a nuclear stress test already compensated the physician for interpreting and reporting the tests results. This is called “unbundling” and occurs when a medical biller falsely adds additional CPT codes for services – such as interpreting the test – that are already encompassed by the CPT code for the nuclear stress test itself. In unbundling in this way, however, Engage Medical ignored the plain language in the applicable CPT coding manuals that specifically told coders not to use the reporting and interpretation CPT codes when billing for nuclear stress tests. Billing staff at Engage Medical learned that by merely adding these codes it could increase the amount Medicare and other federally insured medical programs would pay to the medical provider clients.
In 2009, Engage Medical contracted with Advanced Cardiology Center and its three physician owners: Pankaj Lal, M.D., Mubashar Choudry, M.D. and Moshin Ijaz, M.D. Advanced Cardiology hired Engage Medical to re-bill claims for nuclear stress tests that Advanced Cardiology had already performed, billed and been paid for, in some cases years before. Advanced Cardiology gave Engage Medical access to Advanced Cardiology’s billing files and Engage Medical isolated the instances where Advanced Cardiology had performed and been paid for nuclear stress tests. Using its false billing model, Engage Medical resubmitted the nuclear stress tests for payment a second time, using the CPT codes that reflected a distinct or repeat service, and also added the unbundled code for interpretation. Unlike the internists, however, Advanced Cardiology did not retain Engage Medical to bill claims after February 2010 and thus Advanced Cardiology did not give Engage Medical access to Advanced Cardiology medical records of its patients beyond that time. Rather, Advanced Cardiology employed the Engage Medical model itself, with its own billers applying the false CPT codes to new tests that the cardiologists at Advanced Cardiology performed.
The claims settled by this agreement are allegations, and there has been no determination of liability. The settlement was the result of an investigation by the United States Attorney’s Office for the District of Maryland, with assistance from the Office of Inspector General for the Department of Health and Human Services. Assistant U.S. Attorney Allen Loucks handled the case, and auditor Mary Hammond and investigator Steve Capobianco in the U.S. Attorney’s Office, assisted in this investigation.