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On August 3, North Country Neurology, P.C., a physician-owned medical practice located in Watertown, NY (the “Practice”), reached a settlement with the U.S. Attorney’s Office for the Northern District of New York to pay $850,000 for submitting false Medicare claims for payment.

Among other things, the Practice admitted to having submitted 120 claims between September 2015 and January 2019 that improperly listed a physician as the rendering provider for services rendered by a physician assistant when no physician was physically present in the office and immediately available to provide assistance and direction during a procedure.

Provided that several requirements are met, Medicare allows medical practices to bill for services rendered by a non-physician practitioner (NPP), such as a physician assistant, that are “incident to” services rendered by a physician. Under these circumstances, the services may be billed in the name of the physician although not personally rendered by that physician. A physician must directly supervise the NPP providing the services, meaning that the physician must be present in the office suite and immediately available to provide assistance. Medicare reimbursement for procedures rendered by NPPs who were not supervised by a physician is less than reimbursement for those services would be if the NPP were supervised.

Moreover, the Practice admitted that it knew or should have known that it was improper to submit claims to Medicare under a physician’s name for services provided by an NPP when the physician was not present in the office; several years earlier, its billing company notified the Practice’s owner of “incident to” billing violations it had committed.

As part of another scheme, the Practice admitted that its providers administered and the Practice billed Medicare for Botox injections that were paid for by another insurer, in disregard of the fact that Medicare reimbursement for the administration of Botox includes reimbursement for the cost of the drug.

This recent settlement demonstrates the U.S. government’s intention to continue to defend the integrity of federal healthcare programs against fraud, waste, and abuse.

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