A physician in Frisco Texas has agreed to pay $3.5 million to resolve claims he violated the knowingly submitting or causing the submission of false claims for evaluation and management services that were not performed, the Justice Department said in a May 30 news release.
What happened?
- From April 2020 through October 2021, Samad Khan, MD, who owns SK Primary Care, allegedly submitted around 400,000 claims for high-level evaluation and management services, even though services were actually limited to specimen collection done by medical assistants at walk-up or drive-through testing sites.
- Instead of using CPT Code 99211 (for specimen collection), Dr. Khan and SK Primary Care allegedly used higher-level codes, inflating reimbursement amounts.
- SK Primary Care often submitted two claims per patient — one for the test and one for delivering results. The second claim was also billed as an E/M service, even though results were often communicated impersonally via text, email or a scripted phone call by staff with no clinical interaction.
- The misconduct allegedly occurred in conjunction with SK Primary Care’s management company, which was involved in instructing the use of inappropriate billing codes to maximize reimbursement.
