SAN ANTONIO – Three separate healthcare providers in the Western District of Texas have agreed to pay a collective amount of $1,056,340.50 to resolve liability under the False Claims Act for alleged improper billing of electroacupuncture devices.
These vendors – Ledger Foot & Ankle, PA of Harker Heights, Superior Physical Medicine of Round Rock and Precision Spine and Pain Management of San Antonio – billed Medicare and/or TRICARE for neurostimulator implantation, a surgical procedure that usually requires a room for surgery. surgery and is reimbursable by federal health programs. In these matters, the billed procedure actually involved a non-surgical, non-invasive application of the devices that is not reimbursable by federal health programs.
Between February 2018 and January 2020, Dr. Harold Ledger, DPM, of Harker Heights, through his practice, Ledger Foot & Ankle, P.A., charged Medicare to apply ANSiStim devices to beneficiaries as if they were implantable neurostimulators. Certain Medicare beneficiaries were also identified as having TRICARE benefits, which were later billed to the program as a secondary insurer. Dr. Ledger will pay a total of $535,000.00 to settle his liability under the False Claims Act.
Between December 2016 and September 2018, the SPR Medical Group (formerly known as Atlas Medical Group), d / b / a Superior Physical Medicine, (“Superior”) billed Medicare for applying the ANSiStim and STIVAX devices as if they were neurostimulators implantable. Following a Medicare audit of two neurostimulation procedures, Superior initiated a full refund of Medicare funds received for those two claims and conducted an internal audit of all claims. Superior’s self-reported claims were improperly charged and agreed to pay a total of $338,150.50 to settle any potential liability under the False Claims Act.
Between March 1 and April 2019, Dr. Yurii Borshch, through his Precision Spine and Pain Management practice, urged Medicare to apply ANSiStim devices to beneficiaries as if they were implantable neurostimulators. While the investigation and settlement negotiations were pending, Dr. Borshch initiated reimbursement payments to Medicare for the identified claims and paid a total of $183,190.00 to resolve potential liability under the False Claims Act.
The civil actions resolved are allegations only and do not constitute an admission of liability by any of the identified practitioners.
These issues were investigated by the US Department of Health and Human Services at the US Inspector General. All three deals were negotiated on behalf of the government by Assistant US Attorney Erin M. Van De Walle.