United States Reaches Settlement With Glenn Dale Internist To Resolve False Claims Act Allegations Relating To Medically Unnecessary Procedures
FOR IMMEDIATE RELEASE CONTACT ELIZABETH MORSE
www.justice.gov/usao/md (410) 209-4885
Baltimore, Maryland – Nwaehihie H. Onyeaghala, M.D., an internist in Glenn Dale, Maryland, that operates his medical practice in a limited liability corporation named Krystal Medical Associates, LLC, has agreed to pay the United States $1,000,000.00 to settle allegations that he submitted false claims to the United States for medically unnecessary autonomic nervous function tests and peripheral vascular tests.
The settlement agreement was announced today by Acting United States Attorney for the District of Maryland Stephen M. Schenning, Nick DiGuilio, Special Agent in Charge of the Office of Inspector General for the Department of Health and Human Services and Maryland Attorney General, Brian Frosh.
In his practice, Dr. Onyeaghala administered central and peripheral autonomic nervous function tests and peripheral vascular tests. Autonomic nervous function disorders are rare and tests conducted to determine such disorders should be done only after a clinician suspects an autonomic nervous function disorder. Furthermore, such tests should be conducted only one time per beneficiary, with the necessary equipment and by clinicians with specialized training to administer and interpret these tests. The CPT codes that Dr. Onyeaghala used for central autonomic nervous function tests were CPT codes 95921, 95922 and 95924; he used CPT code 95923 for peripheral autonomic nervous function tests.
Peripheral vascular testing is indicated when a patient presents with leg pain and an examination reveals diminished peripheral arterial pulses. The purpose of monitoring a patient that presents with these symptoms is to see if a patient’s arterial insufficiency progresses to a point where surgical intervention is needed. The CPT code that Dr. Onyeagahala used to test the peripheral vascular system was CPT code 93922 which is a “limited bilateral noninvasive physiologic study of the upper or lower arteries.”
According to the settlement agreement, from January 1, 2013 to January 28, 2017, Dr. Onyeaghala submitted claims to Medicare and Medicaid for medically unnecessary autonomic nervous function tests. The United States alleged that autonomic nervous function tests were not medically necessary because Dr. Onyeaghala lacked the necessary equipment to conduct the tests, the patients did not have an autonomic nervous function disorder before the test was conducted, Dr. Onyeaghala lacked the specific training to conduct such tests and he only used the tests to monitor patient symptoms, not make any clinical decisions about future patient care. With regard to the peripheral vascular tests, the United States alleged that Dr. Onyeaghala conducted these tests at a frequency per beneficiary that was not medically necessary. Dr. Onyeaghala denied the allegations.
Also as part of the settlement, Nwaehihie Onyeaghala, M.D. has agreed to enter into an expansive, 3 year Integrity Agreement that provides for procedures and reviews to be put in place to avoid and promptly detect conduct similar to that which gave rise to the settlement.
The civil settlement was reached by the U.S. Attorney’s Office for the District of Maryland. The Integrity Agreement was negotiated by the Office of the Counsel to the Inspector General of the Department of Health and Human Services.
This case arose from a recent initiative inside the U.S. Attorney’s Office. The United States Attorney’s Office has dedicated resources to enable it to review Medicare billing data. The review of that data has enabled the United States Attorney’s Office to identify areas of concern where it appears that billing irregularities may have taken place. Partnering with the effected agencies, the United States Attorney’s Office has developed the ability to investigate these billing irregularities to determine whether the matter is appropriate for treatment under the False Claims Act.
Acting U.S. Attorney Stephen M. Schenning commended the HHS Office of Inspector General for its work in the investigation. Mr. Schenning also thanked Assistant United States Attorney Thomas Corcoran, who handled the case.