States Attorney's Office District of Connecticut
|September 21, 2010||
TORRINGTON MEDICAL PRACTICE AGREES TO PAY $247K TO SETTLE FALSE CLAIMS ACTS ALLEGATIONS
David B. Fein, United States Attorney for the District of Connecticut, today announced that ARTHRITIS AND ALLERGY ASSOCIATES, P.C., with offices located at 538 Litchfield Street in Torrington, has entered into a civil settlement agreement with the government to resolve allegations that the medical practice violated the False Claims Act by submitting false claims to the Medicare program.
According to the government’s allegations, from 2004 through 2009, ARTHRITIS AND ALLERGY ASSOCIATES, P.C. (“ARTHRITIS AND ALLERGY”) improperly billed the Medicare program for facet joint blocks/injections (treatment relating to back pain) that were not performed using fluoroscopic guidance (real-time radiologic imaging). The government has further alleged that, from 1999 through the first quarter of 2009, ARTHRITIS AND ALLERGY improperly billed the Medicare program for services rendered by unlicensed individuals.
“The health care system relies on providers to bill government health care programs honestly and accurately,” U.S. Attorney Fein stated. “Abusing Medicare billing rules siphons critical resources away from Medicare and other government health care programs. Health care fraud is a national problem that the United States Attorney’s Office is devoted to combating.”
Facet joint blocks are a method of documenting and confirming certain types of biomechanical pain of the spine. The relevant Medicare policies in effect during the time period covered by the settlement agreement stated that “[i]t is not possible to accurately place needles within the facet joint or at the medial branch without fluoroscopic guidance, ” and “Paravertebral blocks, facet joint injections, and medial branch blocks should be performed utilizing direct visualization with fluoroscopy. Blocks performed without the use of fluoroscopy are considered not medically necessary.”
The policies instructed providers that if fluoroscopy is not used, providers should bill for less expensive single tendon injections, but not for facet joint injections. However, ARTHRITIS AND ALLERGY routinely billed the Medicare program for facet joint injections without using fluoroscopic guidance. During the relevant time period, Medicare paid, on average, approximately $250 for facet joint injections and approximately $49 for single tendon injections.
The government also has alleged that ARTHRITIS AND ALLERGY improperly billed Medicare for services provided by individuals not licensed to provide those services. Specifically, between 1999 and April 2005, ARTHRITIS AND ALLERGY had a Medical Assistant preparing and administering antigens. In addition, between 2006 and the first quarter of 2009, ARTHRITIS AND ALLERGY had a radiographer administering injections of antigens. Medicare requires physicians or licensed non-physician practitioners to prepare antigens, and requires antigens to be administered by physicians or by a properly instructed person authorized to perform the service under state law.
In Connecticut, medication administration is a licensed activity, unless a specific statutory exemption exists. There is no statutory exemption in Connecticut permitting medical assistants to administer antigens in private practice. Additionally, Connecticut expressly limits the injections a radiographer may administer to those for diagnostic procedures.
To settle allegations under the False Claims Act, ARTHRITIS AND ALLERGY agreed to pay $247,036.72, which covers conduct occurring from 1999 through the first quarter of 2009.
A complaint against ARTHRITIS AND ALLERGY was filed in the United States District Court in Connecticut under the qui tam, or whistleblower, provisions of the False Claims Act. The complaint alleged that ARTHRITIS AND ALLERGY improperly billed for services rendered by unlicensed professionals. The relator, or “whistleblower,” Ms. Chwee Cass, a former employee of ARTHRITIS AND ALLERGY, will receive a share of the proceeds of the settlement in the amount of $41,996.24.
The whistleblower provisions of the False Claims Act provide that the whistleblower is entitled to receive a percentage of the proceeds of any judgment or settlement recovered by the government.
In entering into the civil settlement agreement, ARTHRITIS AND ALLERGY did not admit liability.
This case was investigated by the Office of Inspector General for the Department of Health and Human Services. The case was prosecuted by Assistant United States Attorney Anne F. Thidemann, along with Auditor Kevin A. Saunders.
People who suspect health care fraud are encouraged to report it by calling 1-800-HHS-TIPS, or the Health Care Fraud Task Force at (203) 785-9270.
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