Upstate New York Urgent Care Practice and its Physician Owner to Pay $110,000 for Submitting False Claims to Medicare
ALBANY, NEW YORK – Mountain Medical Services (Mountain Medical) and its owner, Michael Pond, M.D., have agreed to pay $110,000 under the False Claims Act to resolve allegations that they knowingly billed the federal government for services at a higher rate than appropriate, announced United States Attorney Grant C. Jaquith.
From January 2013 through October 2015, Mountain Medical employed physician assistants and nurse practitioners at its urgent care facilities in Lake Placid, Saranac Lake, Malone, and Massena, New York. Most of these facilities operated seven days a week, for several hours each day, often without a physician present. Nevertheless, during this period, Mountain Medical billed more than 99% of its Medicare services as though the services had been rendered or directly supervised by a physician. Medicare reimbursement rules provide higher levels of reimbursement for services rendered by a physician, and for services rendered by a non-physician practitioner who is directly supervised by a physician who both remains actively involved in the patient’s treatment and is present in the office suite when services are rendered, than for services rendered by a non-physician operating with less physician supervision and involvement.
“The continued vitality of our federal health care system depends on honest billing for services,” said United States Attorney Jaquith. “As this settlement illustrates, we are committed to ensuring that providers who knowingly violate Medicare requirements are held accountable.”
“Mountain Medical Services and Dr. Pond, like all health care providers, must be held to a high standard of ethical behavior,” said Scott J. Lampert, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General’s New York Region (HHS-OIG). “HHS-OIG will continue to ensure that providers who bill federal health care programs do so in an honest manner.”
This settlement was entered in connection with a nationwide law enforcement operation targeting health care fraud, announced today by Attorney General Jeff Sessions and other officials in Washington, D.C.
The investigation and settlement were the result of a coordinated effort among the U.S. Attorney’s Office for the Northern District of New York, HHS-OIG, and the Federal Bureau of Investigation. The United States was represented by Assistant United States Attorney Adam J. Katz.