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Department of Justice
U.S. Attorney’s Office
District of Rhode Island

FOR IMMEDIATE RELEASE
Thursday, November 5, 2015

RI Dermatology and Cosmetic Center Pays More Than $150,000 to Settle Allegations of Upcoding Medicare Claims

PROVIDENCE, R.I. – United States Attorney Peter F. Neronha and Phillip Coyne, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), New England Region, announced today that Rhode Island Dermatology and Cosmetic Center, LLC, and Rhode Island Dermatology OBS, LLC, of Lincoln, have paid $152,043.25 to resolve civil allegations that they violated the federal False Claims Act by billing Medicare for some patient services and procedures performed at rates higher than were warranted.

Based on an investigation conducted by the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG) and the United States Attorney’s Office, the United States alleged that, between 2009 and 2014, Rhode Island Dermatology, which provides dermatology, plastic surgery, and cosmetic surgery services, billed Medicare for surgical closure procedures at a higher rate of complexity than was supported by certain patients’ condition or the circumstances of the closure, and which should properly have been classified at a lower billing rate for less complex procedures.  The amount that Medicare pays for a given medical or surgical procedure is frequently dependent on the complexity of that procedure.  Upcoding, or billing for a level of complexity that is not warranted by a patient’s actual condition and treatment, results in improperly higher payments for care that should have actually been reimbursed by Medicare at a lower rate.

The matter was settled prior to litigation, without an admission of liability or wrongdoing on the part of the practice.

The case was litigated by Assistant U.S. Attorney Zachary A. Cunha.

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Contact:

Jim Martin (401) 709-5357

email: USARI.Media@usdoj.gov

on Twitter @USAO_RI

Topic(s): 
Health Care Fraud
Component(s): 
Press Release Number: 
15-99
Updated November 5, 2015