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Feds crack down on pain procedure billing fraud

Multiple physicians and chiropractors have agreed to pay the federal government millions of dollars over the past six months to resolve fraudulent billing allegations related to pain management procedures.

1. Marte Martinez Jr., MD, an anesthesiologists and pain management physician in Loredo, Texas, paid $340,437 to settle allegations he billed Medicare for improper neurostimulator implantation from August 2019 to February 2020. The U.S. Justice Department announced his settlement June 11.

2. Two chiropractic practices in Pennsylvania, Discover Optimal Health of Brookhaven (Pa.), and Yucha Medical Pain Management & Chiropractic Rehabilitation in Pottstown, along with the owners of both practices paid more than $800,000 to resolve allegations the groups wrongly billed for nonsurgical applications of the P-stim procedure ANSiStim as a surgically implanted neurostimulator, which Medicare does not cover. The Justice Department released a statement June 11 about the settlement.

3. Dr. Harold Ledger, a podiatrist, owner of Ledger Foot & Ankle in Harker Heights, Texas, agreed to pay $535,000 to resolve false billing allegations associated with ANSiStim devices, according to a June 10 Justice Department statement.

4. Yurii Borshch, MD, of Precision Spine and Pain Management in San Antonio, refunded Medicare payments related to the ANSiStim devices and paid $183,190 to settle billing fraud allegations, according to a June 10 Justice Department statement.

5. Superior Physical Medicine in Round Rock, Texas, admitted to improperly billing for ANSiStim and Stivax, a neurostimulation device, from December 2016 to September 2018 and paid $338,150 in addition to repaying Medicare funds to resolve the fraud allegations. The Justice Department released a statement about the resolution June 10.

6. Suhyun An, a Houston-based chiropractor who owns and manages Campbell Medical Clinic, will pay $2.6 million to the federal government and forego participating in federal healthcare programs for 10 years to resolve billing fraud allegations. Ms. An is accused of wrongly billing Medicare and Tricare for neurostimulator electrode implantations that were performed by nurses instead of physicians, according to a June 8 statement from the Justice Department.

7. Three spine care providers in Tennessee paid nearly $2 million to resolve improper billing claims for P-stim devices earlier this year, according to a Jan. 4 Justice Department statement:

  • James Anderson, MD, owner of Goodlettsville-based Affiliated Neurologists paid $1 million and agreed to allow the federal government to monitor his billing practices for the next three years.
  • Charles Spencer, a chiropractor and owner of Murfreesboro-based Total Family Health & Wellness, agreed to pay $700,000 over five years to settle the allegations.
  • Mitchell Shea, a chiropractor and owner of Cookeville-based Chiro2Med of Tennessee, agreed to pay $20,000 over five years to resolve the issue.

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