Florida-based durable medical equipment supplier Electrostim Medical Services, Inc. (EMSI) and its Founder and Chairman Mario Garcia, Jr. have together agreed to pay, based on their limited ability to do so, $20 million to resolve allegations that they violated the False Claims Act by billing federal healthcare programs for excessive and medically unnecessary supplies associated with Transcutaneous Electrical Nerve Stimulation (TENS) and related devices. The government alleges that, from at least 2018 through 2019, EMSI and Garcia profited by marketing its TENS and related electrical stimulation devices to beneficiaries of federal healthcare programs that reimbursed for unbundled supply codes—primarily TRICARE.
EMSI typically billed TRICARE for replacement supplies on a monthly basis, including improperly billing for supplies during the first month despite knowing that patients received kits that contained all initial supplies. EMSI’s improper billing practices also included submitting claims for a monthly resupply of traditional electrodes for the same beneficiaries to whom it billed for a garment, despite knowing that patients with a garment did not need traditional electrodes. According to the government, EMSI and Garcia knowingly executed this scheme without regard to medical necessity, resulting in false claims to federal programs. The result was that many TRICARE beneficiaries were forced to pay co-pays for excessive amounts of supplies they did not need or want.
