DOJ Cracks Down on Neurostimulator Fraud

A Texas podiatrist who conspired to submit false claims for the placement of electro-acupuncture devices has agreed to pay $90,000 to settle the case. He is the latest in a group of other medical professionals, along with a medical sales representative, alleged to have taken part in similar schemes.

According to the U.S. Department of Justice, between March 1, 2018, and Nov. 30, 2019, Dr. Amr El-Khashab, along with Dr. Judith Rubin, billed Medicare for the surgical implantation of neurostimulator electrodes – something for which Medicare pays thousands per procedure and which requires the use of an operating room.

However, neither performed the surgery. Instead, patients received devices used for electro-acupuncture, which only involves inserting needles into patients’ ears and taping the neurostimulator behind them with an adhesive. Medicare does not reimburse for electro-acupuncture devices as implantable neurostimulators.

Rubin, 67, settled the case for $865,000 in April 2022.

The Southern District of Texas has resolved the following similar cases:

  • Dr. Jaime Robledo, an anesthesiologist, settled for $100,000.
  • Dr. Syed Nasir, a pain management physician, settled for $530,000.
  • Stacy Hawkins, a chiropractor, settled for $273,000.
  • Suhyun An, a chiropractor, settled for $2.6 million and was excluded from participating in federal healthcare programs for ten years. It was alleged she fraudulently obtained more than $3.9 million from the Medicare and TRICARE programs. The lawsuit also alleges nurse practitioners working for An learned how to apply the devices by watching YouTube videos and participating in trainings with sales representatives. 
  • Dr. Marte A. Martinez Jr., an anesthesiologist and pain management physician, settled for more than $340,000.
  • Dr. Emad Bishai, an anesthesiologist and pain management physician, settled for more than $520,000 and agreed to a seven-year-period of exclusion from participation in any federal healthcare programs.
  • Matthew Thibaut, a medical sales representative, settled for $100,000. It was alleged he sold the medical devices to customers who he knew would falsely bill Medicare and therefore assisted in the submission of false claims.

In October 2021, The U.S. Department of Health and Human Services Office of Inspector General released the results of an audit that found 40 percent of healthcare providers did not meet Medicare documentation requirements when billing for neurostimulator implantation surgeries. This resulted in more than $636 million in unallowable Medicare payments and $54 million in unnecessary copays and deductibles during 2016 and 2017. The OIG noted that these unallowable payments occurred because providers did not include sufficient documentation in the medical records to support that Medicare coverage requirements were met.

Though OIG did not indicate those payments were the result of fraudulent activity, it appears that improved oversight for such payments was needed. The Health Law Offices of Anthony C. Vitale can assist clients in developing an effective program to identify and correct any problems before your practice becomes the target of an investigation. If you or your company become the subject of an investigation, an effective compliance program may help you mitigate or eliminate potential sanctions, penalties, and program exclusions.

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