United States Reaches Settlement With Riverdale 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 – Sureshkumar Muttath, M.D., an internist in Riverdale, Maryland, has agreed to pay the United States $1,526,038 to settle allegations that he submitted false claims to the United States for medically unnecessary autonomic nervous function tests and neurobehavioral status exams.
The settlement agreement was announced today by United States Attorney for the District of Maryland Robert K. Hur, Special Agent in Charge of the Office of Inspector General for the Department of Health and Human Services, Maureen Dixon, and Maryland Attorney General, Brian Frosh.
In his practice, Dr. Muttath administered central autonomic nervous function tests and mini-mental exams. Autonomic nervous function disorders are relatively uncommon disorders and tests conducted to determine such disorders should be done only after a clinician suspects such a disorder. Furthermore, according to Local Coverage Determinations (“LCDs”) from Novitas, the Medicare administrative contractor for Maryland, 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. Muttath used for central autonomic nervous function tests were 95921, 95922, and 95924. Additionally, Dr. Muttath assessed patients using mini-mental status exams that he billed as a neurobehavioral status exams using CPT code 96116.
According to the settlement agreement, from January 1, 2011 to June 30, 2017, Dr. Muttath submitted claims to Medicare and Medicaid for medically unnecessary autonomic nervous function tests (CPT codes 95921-95924). The United States contends that these tests were not medically necessary and otherwise were excluded from coverage under both programs because Dr. Muttath did not have the necessary equipment to perform these tests; the patients who underwent the testing had not been diagnosed clinically with an autonomic function disorder before Dr. Muttath conducted the tests; Dr. Muttath did not have the specific training required to conduct autonomic function tests or interpret the results thereof; Dr. Muttath failed to follow Novitas’s Local Coverage Determinations (L34788 and L35395) regarding coverage indications, limitations, and medical necessity for autonomic function testing; and Dr. Muttath performed autonomic function tests merely to monitor patient symptoms or conduct patient screenings without signs or symptoms of autonomic dysfunction and not to make any clinical decisions or manage patient care.
With regard to the neurobehavioral status exam claims billed by Dr. Muttath using CPT code 96116, the United States alleges that Dr. Muttath misrepresented the services he actually performed (mini-mental status exams) as neurobehavioral status exams because he failed to spend the required amount of time either face-to-face with the patient or interpreting the tests and preparing the reports and because he did not conduct the required assessments of the patients’ thinking, reasoning, and judgment to submit claims under CPT code 96116.
Dr. Muttath denied the United States’ allegations.
Also as part of the settlement, Sureshkumar Muttath, M.D. has agreed to enter into an expansive, three-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 United States 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 United States 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 affected agencies, the United States Attorney’s Office has developed the ability to investigate these billing irregularities to determine whether the matter should be pursued under the False Claims Act.
United States Attorney Robert K. Hur commended the HHS Office of Inspector General for its work in the investigation. Mr. Hur also thanked Assistant United States Attorneys Thomas Corcoran and Neil White who handled the case.