Acting United States Attorney Lisa G. Johnston announced that Med-Surg Physician Group Inc. and its owner Oluyemisi Sangodeyi, MD, have agreed to pay the United States $152,382.70 to resolve civil allegations that they violated the federal False Claims Act by submitting false claims for payment to Medicare and Medicaid and falsely certifying compliance with program requirements. Med-Surg Physician Group, Inc. (Med-Surg) is a medical practice based in Beckley, West Virginia, providing both general internal medicine services as well as medication assisted treatment (MAT) for substance use disorder. Analysis of Med-Surg’s Medicare and Medicaid claims revealed an unusual billing pattern for Healthcare Common Procedure Coding System (HCPCS) procedure code Q3014 (telehealth originating site facility fee). This billing code is intended to allow an enrolled facility where a patient is physically located to recoup costs associated with connecting the patient in the facility with an outside provider such as a specialist for telehealth services. Federal regulations specify that “only the originating site may bill for the originating site facility fee.”
After conducting patient interviews, investigators determined that Med-Surg was regularly billing procedure code Q3014 for telehealth visits where the patient was at home, in violation of federal law and regulations that specify that the facility fee is not payable where the patient’s originating site is their home. Despite the clear requirements of the statutes, regulations, and policy guidance, between March 25, 2020, and January 27, 2021, Med-Surg routinely added the Q3014 billing code when submitting claims to Medicare and Medicaid for telehealth visits. During the relevant time period, Med-Surg received a total of $76,191.35 from Medicare and Medicaid as a result of this inappropriate billing.
