Tri-State Specialists in Sioux City, Iowa, will pay hundreds of thousands of dollars to resolve billing fraud allegations.
1. The government accused Tri-State of fraudulently billing for cosmetic procedures performed by a plastic surgeon. The group allegedly billed for procedures that aren't reimbursable by government healthcare programs, such as panniculectomies and abdominoplasties, and claimed they were medically necessary when they were not.
2. The plastic surgeon also allegedly billed for high-value muscle flap and adjacent tissue transfer surgical procedures without delivering on those services.
3. The government also said the plastic surgeon billed for high-value office visits requiring a comprehensive history, exam and detailed supporting documentation for complex medical decision-making without rendering those services.
4. The plastic surgeon is no longer with Tri-State, but the federal government argued the practice was liable because they were aware of his actions and he acted as an agent of the group.
5. Tri-State will pay $612,501.44 to resolve the allegations. Since the civil suit stemmed from a whistleblower suit, the whistleblower will receive a portion of the recovery.