Traverse City Practice Pays Over $600,000 To Resolve False Claims Act Allegations Regarding Anesthesia Billing
GRAND RAPIDS, MICHIGAN – U.S. Attorney Andrew Birge announced today that Traverse Anesthesia Associates, P.C. ("TAA"), and six of its anesthesiologists, agreed to pay the United States $607,966 to resolve allegations, under the federal False Claims Act, that they falsely submitted certain anesthesia claims to Medicare. TAA is a medical professional corporation that provides anesthesiology and pain management services at a number of hospitals and outpatient sites in the Traverse City region. The United States specifically contended that, for certain claims billed as medically directed anesthesia services, TAA and its anesthesiologists did not meet the regulatory requirements and conditions of payment for billing those services as medically directed.
This case resulted from a civil lawsuit filed by two whistleblowers who previously worked as employees at TAA. The lawsuit, known as a qui tam action, was filed under the False Claims Act, which allows private whistleblowers to bring lawsuits on behalf of the United States and receive a share of any recoveries. In this case, the Government partially intervened in the whistleblowers’ lawsuit. The whistleblowers will collectively receive over $120,000 of the settlement proceeds. The qui tam case is docketed as United States, et al. ex rel. Stone, et al., v. Traverse Anesthesia Associates, P.C., et al., No. 1:18-cv-1416 (W.D. Mich.).
"Those who provide medical services to Medicare beneficiaries and then bill for those services, must ensure compliance with Medicare’s billing requirements," said U.S. Attorney Birge. "My office investigates allegations of fraudulent billing and will enforce compliance with Medicare’s regulations. Billing Medicare for one level of service, while providing another, is exactly the type of activity that my office will aggressively pursue."
This case was investigated by the U.S. Department of Health & Human Services, Office of Inspector General, and the U.S. Attorney’s Office for the Western District of Michigan. Assistant U.S. Attorney Andrew J. Hull represented the United States.
The claims resolved by the settlement are allegations only. There has been no determination of liability.