- Alabama Ambulance Provider Settles Case Involving False Claims
- On June 28, 2019, Samaritan EMS, Inc. (Samaritan), Union Grove, Alabama, entered into a $ 942,373.67 settlement agreement with OIG. The settlement agreement resolves allegations that Samaritan submitted basic and advanced life support ambulance claims where the trips were to destinations for which ambulance services are not covered by Medicare, such as trips to diagnostic and therapeutic sites (and the associated “return” trip was to a residence).
- Missouri Physician Agrees to Voluntary Exclusion
- On May 22, 2019, On-Site Imaging, LLC (On-Site), Morganville, New Jersey, entered into an $ 82,065.08 settlement agreement with OIG. The settlement agreement resolves allegations that On-Site submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 96965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which On-Site submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service. The OIG further contends that the claims submitted for HCPCS code 93965 were for a procedure that should not have been separately billed and was not medically necessary.
- Diagnostic Services Provider Settles Case Involving False Claims
- On May 22, 2019, On-Site Imaging, LLC (On-Site), Morganville, New Jersey, entered into an $ 82,065.08 settlement agreement with OIG. The settlement agreement resolves allegations that On-Site submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 96965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which On-Site submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service. The OIG further contends that the claims submitted for HCPCS code 93965 were for a procedure that should not have been separately billed and was not medically necessary.
- California Physician and Practice Settle False and Fraudulent Claims Case
- On April 12, 2019, Complete Women Care, Inc., and Miriam Mackovic-Basic, M.D. (collectively, “CWC”), with multiple locations in Los Angeles County, California, entered into a $ 258,045 settlement agreement with OIG. The settlement agreement resolves allegations that CWC submitted claims to Medicare for items or services that it knew or should have known were not provided as claimed and were false or fraudulent. Specifically, OIG contended that CWC submitted claims for: (1) diagnostic electromyography services using CPT Code 51784 and diagnostic anorectal manometry (ARM) services using CPT Code 91122 when therapeutic, not diagnostic services, had been provided; (2) ARM services using CPT Code 91122 that were not performed according to CMS guidelines; (3) pelvic floor electrical stimulation that was not preceded by a four-week course of failed pelvic muscle exercise training; and (4) in 13 instances, evaluation and management services using CPT Code 99214 that did not meet the criteria for billing under that code.
- Alabama Ambulance Provider Settles Case Involving False Claims
- On February 13, 2019, Medical Diagnostics Services, Inc. (MDS), with locations in Michigan and Illinois, entered into an $ 878,180.08 settlement agreement with OIG. The settlement agreement resolves allegations that MDS submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 96965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which MDS submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service. The OIG further contends that the claims submitted for HCPCS code 93965 were for a procedure that should not have been separately billed and was not medically necessary.
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