Medicare Compliance & Reimbursement
Feds Settle FCA Allegations for $6.5 Million
Case serves as a stern reminder on medical necessity. Over the past few years, the feds have repeatedly targeted fraudulent urine drug testing, so this case shouldn’t surprise you — but the settlement numbers might. Details: On Aug. 24, Detroit-based physician Rajendra Bothra and two entities that he owned, the Pain Center USA, PLLC, and Interventional Pain Center, PLLC, agreed to pay more than $6.5 million to settle False Claims Act (FCA) allegations. Between 2015 and 2018, Bothra and the two other defendants billed Medicare and Medicaid for medically unnecessary urine drug tests and additional lab work that were irrelevant to patients’ diagnoses and treatments, a Department of Justice release notes. In addition to the urine testing fraud, Bothra billed Medicare and Medicaid for medically unnecessary moderate sedation services and back braces. “This settlement underscores the important role that medical providers have in ensuring that the claims submitted to Federal health care programs are medically necessary,” said Mario M. Pinto, Special Agent in Charge of the HHS Office of Inspector General in a release. “Our office remains committed to working with our law enforcement partners to ensure that health care providers who violate the False Claims Act are held accountable.” See the case breakdown at www.justice.gov/usao-edmi/pr/ michigan-doctor-pay-65-million-resolve-false-claims-act-allegations.
Medicare Compliance & Reimbursement
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Feds Settle FCA Allegations for $6.5 Million
Case serves as a stern reminder on medical necessity. Over the past few years, the [...]
