A 39-year-old Texas podiatrist has agreed to pay to resolve allegations he submitted false claims for the placement of electro-acupuncture devices. The man had previously been employed by another podiatrist, and the two of them had billed Medicare for the surgical implantation of neurostimulator electrodes. These are invasive procedures usually requiring use of an operating room. Medicare pays thousands of dollars per procedure.
However, neither of the podiatrists performed these surgical procedures. Instead, patients received devices used for electro-acupuncture, which only involves inserting needles into patients’ ears and taping the neurostimulator behind them with an adhesive. The other podiatrist previously entered into an $865,000 settlement to address these allegations.
To date, this is the ninth case the Southern District of Texas has resolved for similar conduct. The other matters included settlements with an anesthesiologist, three pain doctors, two chiropractors, and a marketing representative.
The US Attorney’s Office conducted the investigation with the Department of Health and Human Services (HHS) Office of Inspector General (OIG) and the Unified Program Integrity Contractor for Medicare.
Compliance Perspective
Issue
Providers must ensure that the claims they submit to Medicare and Medicaid are true and accurate. One of the most important steps a provider can take is to have a robust internal audit program that monitors and reviews claims. If a provider identifies billing mistakes in the course of those audits, the provider must repay overpayments to Medicare and Medicaid within 60 days to avoid False Claims Act liability. Providers also can disclose billing errors to the OIG through the OIG Self-Disclosure Protocol.
Discussion Points
- Review your policies and procedures for preventing and reporting a false claim and for conducting a Triple Check Process to verify accuracy of Medicare claims. Ensure that your policies are reviewed at least annually and updated when new information becomes available.
- Train all staff upon hire and at least annually on your compliance and ethics policies and procedures and on what can be considered a false claim. Provide training to appropriate staff on the Triple Check Process for ensuring accuracy of all Medicare Part A billing and supporting documentation before claims are submitted. Members of the compliance and ethics committee should periodically receive additional training on compliance and ethics issues in healthcare. Document that these trainings occurred and file the signed document in each employee’s education file.
- Periodically perform audits to ensure all staff are aware of compliance and ethics concerns and understand their responsibility to report any potential compliance and ethics violations to their supervisor, the compliance and ethics officer, or via the anonymous hotline. Audit to ensure that the Triple Check Process is being followed each month before claims are submitted to Medicare, and that any identified irregularities are corrected.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
