Norman Orthopedic Practice Pays $1,537,796 to Resolve Allegations of False Claims Submitted to Federal and State Programs for Medical Services
Oklahoma City, Oklahoma – Orthopedic AND Sports Medicine Center-Norman, P.C., and its physician-owners, Dr. Mark Moses, Dr. David Bobb, Dr. William Harris, Dr. Vytautus Ringus, Dr. Steven Schultz, and Dr. Brad Vogel (collectively "OSC") have paid $1,537,796 to settle civil claims stemming from allegations that they submitted false claims to Medicare, Medicaid, the Department of Veterans Affairs, and TRICARE.
OSC is a medical practice that provides general orthopedic medical services in Norman, Oklahoma. Following an internal review and audit, OSC discovered irregularities in prior billing processes and practices. In August of 2016, OSC proactively contacted the United States to voluntarily disclose the billing irregularities and documentation deficiencies they had identified. Thereafter, the United States investigated the disclosures and issues raised by OSC. Throughout the investigation, and to its credit, OSC provided cooperation and access to both privileged and non-privileged internal documentation, audit, and medical records, as well as access to their consultant statistician.
The voluntary disclosure and investigation revealed that the United States and State of Oklahoma have certain civil claims against OSC for false claims arising under Medicare, Medicaid, TRICARE, and the Veterans Health Administration. Specifically, from January 1, 2010, through December 31, 2015, OSC improperly billed the health care programs for the following: (i) physician extenders without documentation in progress notes to support billing, evaluation, and management codes; (ii) durable medical equipment, prosthetics, orthotics, and supplies ("DMEPOS") where bills had incorrect CPT codes, where documentation did not support proof of delivery of the DMEPOS, and where documentation did not support that the DMEPOS was ordered or medically necessary for the patient; (iii) evaluation and management codes related to hospital consults that were not supported by documentation in progress notes; and (iv) physical therapy where the documentation did not support CPT codes billed and or the number of physical therapy units billed.
In reaching this settlement, OSC did not admit liability, and the government did not make any concessions regarding the legitimacy of the claims. The agreement allows the parties to avoid the delay, expense, inconvenience, and uncertainty involved in litigating the case.
This case was investigated by the Office of Inspector General’s Office of Investigations and Office of Audit Services of the United States Department of Health and Human Services; the Oklahoma Attorney General’s Office’s Medicaid Fraud Control Unit; the United States Department of Veterans Affairs, Office of Inspector General; and the Defense Criminal Investigative Service. The case was prosecuted by First Assistant United States Attorney Robert J. Troester.