GRAND RAPIDS – U.S. Attorney for the Western District of Michigan Mark Totten announced that Javery Pain Institute, PC, located in Grand Rapids, has agreed to pay $215,000 to resolve allegations that it violated the False Claims Act by submitting claims to Medicare for medically unnecessary moderate sedation services and falsifying medical records to support those claims.
“Truthful and accurate medical records are the bedrock of our Medicare system,” said U.S. Attorney Mark Totten. “This settlement reflects the commitment of my office in working with our law enforcement partners to protect the Medicare population and maintain the system of trust and accountability necessary between the patient, physician, and federal healthcare programs.”
The United States alleged that Javery Pain Institute billed Medicare for moderate sedation services in conjunction with certain pain injection procedures when those sedation services did not meet Medicare’s medical necessity requirements. After a Medicaid audit discovered this issue, the practice created template language in its electronic medical records to support medical necessity for these services. The practice then used this templated language for some Medicare beneficiaries receiving moderate sedation services to create medical records that contained statements that were not true. Javery Pain Institute used these statements to justify billing Medicare for moderate sedation services. Additionally, on some occasions, the practice billed Medicare for moderate sedation services when the intraservice time for those procedures was less than the ten minutes required to bill for the service.
“The alleged submission of false claims for medically unnecessary services and falsifying of documentation to justify those services, undermines our federal health care programs and potentially places patients at risk,” said Special Agent in Charge Mario M. Pinto of the U.S. Department of Health and Human Services Office of Inspector General (“HHS-OIG”). “Our agency, working with our law enforcement partners, is committed to working to hold those who seek to defraud federally funded health care programs accountable.”
The resolution obtained in this matter was the result of a coordinated effort between the U.S. Attorney’s Office for the Western District of Michigan and HHS-OIG. Assistant U.S. Attorney Andrew J. Hull investigated the matter.
The claims resolved by the settlement are allegations only, and there has been no determination of liability.