Please E-mail suggested additions, comments and/or corrections to Kent@MoreLaw.Com.
Court: United States District Court for the Eastern District of Tennessee (Knox County)
Plaintiff's Attorney: United States Attorney’s Office
Description: Knoxville, TN: Align Health and Holistic Medical Center, Inc. and Align Health Management, Inc., (collectively “Align”), Eric Anderson, P.A. d/b/a Anderson Chiropractic Clinic (“Anderson Chiropractic”), their owners and a former employee agreed to pay $163,400 to resolve allegations that they knowingly and improperly billed Medicare for electro-acupuncture using peri-auricular stimulation devices in violation of the False Claims Act (“FCA”).
Align and Anderson Chiropractic are outpatient clinics located in Maryville, Tennessee that offer medical and chiropractic services for the treatment of pain. According to the contentions of the United States contained in the settlement agreement, between September 2016 and March 2019 Align and Anderson Chiropractic routinely presented, or caused to be presented, to Medicare false claims for payment for the placement of electro-acupuncture devices on patients. The placement of these devices was improperly billed under code L8679, which resulted in the clinics receiving payments from Medicare to which they were not entitled.
L8679 is a billing code for “implantable neurostimulator, pulse generator” devices that are surgically implanted into the central nervous system or targeted peripheral nerves through procedures that are typically performed by a surgeon in an operating room. However, the United States contends that Align and Anderson Chiropractic falsely billed Medicare under L8679 for electro-acupuncture devices they knew were not surgically implanted into their patients and for procedures that did not involve anesthesia or take place in an operating room. The underlying services for which Align and Anderson Chiropractic submitted the L8679 claims involved application of a device used for electro-acupuncture. Common brand names for this device include P-Stim, Stivax, NeuroStim, ANSiStim, E-Pulse, and NSS-2 Bridge. The electro-acupuncture devices were applied by inserting needles into patients’ ears and by taping the devices behind their ears with an adhesive. Medicare does not reimburse for electro-acupuncture devices billed as neurostimulators and did not reimburse for acupuncture at all during the period of the covered conduct.
In addition to paying the civil settlement, which was based on the parties’ ability to pay, Align, Anderson Chiropractic, and their owners have agreed to enter into an Integrity Agreement (“IA”) with the Office of Inspector General of the Department of Health and Human Services (“OIG-HHS”). The IA requires, among other things, that Align, Anderson Chiropractic, and their owners implement specific measures intended to prevent future health care fraud and to address evolving compliance risks. These measures include training for staff on applicable health care fraud laws and submitting to a claims review conducted by an Independent Review Organization to ensure compliance with Medicare billing requirements.
This investigation resulted from a coordinated effort between the U.S. Attorney’s Office for the Eastern District of Tennessee, OIG-HHS, and the Southeastern Unified Program Integrity Contractor (“UPIC”).
Assistant U.S. Attorney Joseph C. Rodriguez represented the United States.
Outcome: The claims settled by this agreement are allegations only, and there has been no determination of liability.