Another Jacksonville, Florida-based orthopedic group has agreed to settle false claims allegations with Assistant U.S. Attorney, Jason Mehta.
On December 7, 2016, Mehta and the Department of Justice (DOJ) announced that Southeast Orthopedic Specialists (SOS) agreed to pay the government $4.488 million to resolve allegations that it violated the False Claims Act.
The government alleges the group sought reimbursement for about $3 million of services that were questionable because they were not medically necessary and reasonable.
Specifically, the feds claim that SOS knowingly:
- “Certified that it met certain standards related to the “meaningful use” of electronic health records when the practice had, in fact, not met those standards;
- Billed for certain claims as “incident to” physician supervision when no physician was present or there was no verification of any physician being present;
- Billed for certain claims using Modifier 25 signifying that a separate evaluation and management service was performed even when there was no such separate service;
- Billed for certain claims using Modifier 59 signifying that two procedures, rather than one, were billable even when these procedures should have more appropriately been billed as one such procedure;
- Scheduled patients’ follow-up operative visits from 12 weeks following surgery to 14 weeks in an effort to bill for a separate visit outside the normal Medicare 90 days Diagnosis-Related Group charge;
- Used and billed for ultrasound-guided injections routinely even in the absence of medical necessity; and
- Billed for certain physical therapy claims using Modifier KX so as to exceed the Medicare cap on physical therapy, despite the absence of medical necessity.”
Corporate Integrity Agreement
SOS admitted no wrongdoing as part of the settlement, which required the practice to sign a corporate integrity agreement and hire a third-party auditor to review future claims.
The practice has 13 board-certified physicians on staff and employs about 200 other personnel in half a dozen locations throughout Northeastern Florida.
The U.S. Department of Health and Human Services, Office of Inspector General assisted in the case. Mehta said SOS cooperated immediately when confronted with the problems, and the settlement soon followed.
Assistant U.S. Attorney Mehta is making a name for himself in northern Florida. This past August, the prosecutor reached a $7.14 false claims settlement with Jacksonville-based Coastal Spine and Pain over allegations the practice performed medically unnecessary drug screening procedures.
