Attorney General William Tong and United States Attorney Vanessa Roberts Avery announced a $399,440 settlement with Waterbury naturopath Marcos DeEscobar and his company Corebella Health, LLC to resolve allegations that they submitted false claims to, and received overpayments from, Medicare and the Connecticut Medicaid programs. Corebella Health, LLC is a practice that provides medical and wellness services to patients in Waterbury. DeEscobar is a naturopath and the owner of Corebella. The allegations against Corebella and DeEscobar arise out of improper billing for allergy immunotherapy preparation, and office visits, also known as evaluation and management (“E&M”) services. The state and federal governments allege that Corebella and DeEscobar submitted, or caused to be submitted, false claims to Medicare and Medicaid for services that were supposedly rendered by physicians. In reality, the services were rendered by nurse practitioners, did not meet incident-to supervision requirements, and should not have been reimbursed at the higher physician rate.
The state and federal governments allege that Corebella and DeEscobar received overpayments from Medicare and Medicaid for allergy immunotherapy preparation services by submitting claims for more units than were actually prepared. Medicare and Medicaid generally consider E&M services that occur on the same day as a procedure to be part of the work of the procedure, and do not allow a separate payment for the office visit. However, when a significant, separately identifiable service is performed by the same physician on the same date of the procedure, the provider can use “Modifier 25” to bill for both the procedure and the E&M services. The state and federal governments allege that Corebella and DeEscobar caused improper claims to be billed to Medicare and Medicaid by adding Modifier 25 to E&M claims when providing allergy injections when, in fact, no significant, separately identifiable E&M services were provided. To resolve their liability, Corebella and DeEscobar will pay $399,440.55 to the state and federal governments for conduct occurring between January 1, 2016, through December 31, 2018.
