PHILADELPHIA – Two related, inclusive chiropractic practices, including one in North Coventry, and their chiropractor owners have agreed to make payments totaling $ 805,978 to cover False Claims Act liability for alleged improper billing of P-Stim electro acupuncture devices to solve federal prosecutors.
The comparison parties were: Discover Optimal Healthcare of Brookhaven, Delaware County and its owner Jason Weigner and its subsidiary Weigner Healthcare Management Group, LLC; and Yucha Medical Pain Management & Chiropractic Rehabilitation, LLC of North Coventry, and its owners, Randolph E. Yucha and Rodney Gabel, announced acting US attorney Jennifer Arbittier Williams this week.
Officials stated that chiropractors are generally limited in what services they can bill for federal health programs. However, integrative chiropractic practices like Weigner and Yucha may, under certain circumstances, bill for additional services for federal health programs through affiliated medical service providers, in this case a contracted doctor, federal officials said.
From about September 2016 through February 2017, Weigner and Yucha billed Medicare separately, and Weigner also billed the Federal Employees Health Benefit Program for the implantation of neurostimulators – a surgical procedure that usually requires an operating room and is reimbursed by federal health care programs – although the only procedures performed had actually been the non-surgical use of ANSiStim by a non-surgical contract doctor, federal officials said.
ANSiStim is another brand name for the P-Stim device, also known as NeuroStim, Stivax, E-Pulse, and NSS-2 Bridge. ANSiStim devices are attached with an adhesive and a limited number of needles inserted, and their use does not require surgery, anesthesia or an operating room. State health programs do not reimburse devices like ANSiStim, whether they are labeled as an electro-acupuncture device or an implantable neurostimulator.
Weigner sponsored this project at Yucha and received part of Yucha’s profits, announced the federal prosecutor.
For the fraudulently billed P-Stim services, Weigner previously repaid Medicare $ 306,342 and will pay an additional $ 356,150. Likewise, Yucha had repaid $ 94,089 to Medicare and will pay an additional $ 49,397, officials said.
“As we said earlier, using P-Stim devices is not surgery and shouldn’t be billed with the surgical codes improperly passed on by marketers,” Williams said. “If a marketer is promoting a healthcare system like P-Stim that sounds too good to be true, it probably is – and you shouldn’t agree.”
The settlements were the fourth and fifth P-Stim provider settlements announced as part of an ongoing investigation in the Eastern District of Pennsylvania. Other jurisdictions, including the Southern District of Texas, the Southern District of Georgia, and the Middle District of Tennessee, have also taken steps to hold vendors accountable, officials said.
“Our continued enforcement on this string of cases has already won millions back and is a lesson for anyone considering a similar fraudulent billing system – especially those who exploit vulnerable Medicare beneficiaries in search of legitimate pain management solutions,” said Williams.
Williams said providers nationwide are being held accountable by U.S. attorneys and partners in the Centers for Medicare & Medicaid Services ‘Center for Program Integrity, the Department of Health and Human Services’ Office of Inspector General, other federal health programs, and state partners.
“And if you’ve already been involved in a plan like this, it is better to report yourself than let us find you how we’re going to do it,” warned Williams.
“Every time (the Justice Department) stops a fraudulent provider, protects patients, and improves the sustainability of the Medicare program,” added Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid Services. “Measures like these to combat fraud, waste and abuse in our federal programs would not be possible without the successful partnership of CMS, the Ministry of Justice and the Inspector General of the Ministry of Health.”
“Accurate billing of the services provided to Medicare beneficiaries is required by all healthcare providers,” said Maureen R. Dixon, Office of the Inspector General’s special adviser, adding that authorities are continuing to assess track inaccurate billing from P-Stim and similar devices.
The settled civil claims are only allegations and no civil liability has been found, officials said.
The case was investigated by the US Department of Health and Human Services Office of the Inspector General. It was edited by U.S. Assistant Attorney Matthew EK Howatt, Civil Chief Gregory B. David, and Auditor Dawn Wiggins.