Allegations of Federal Health Care Fraud

Surgery Centers and Medical Offices in Brooklyn and New Jersey Settle Allegations of Federal Health Care Fraud

12 Medical Practices and a Physician-Owner to Pay Over $7.4 Million to Resolve Claims of Improper Billing of Medicare and the Federal Employees Health Benefit Program for Acupuncture Procedures

(STL.News) Breon Peace, United States Attorney for the Eastern District of New York, Scott J. Lampert, Special Agent-in-Charge, U.S. Department of Health and Human Services, Office of the Inspector General, New York Region (HHS-OIG), and Norbert E. Vint, Deputy Inspector General, Office of Personnel Management (OPM), announced today that 12 surgery centers and medical offices affiliated with Interventional Pain Management Center P.C. (“IPMC”), a company owned by Dr. Amit Poonia, have agreed to pay $7,447,340.75 to resolve liability under the False Claims Act for claims submitted to federal health care programs for acupuncture treatment.

“This settlement holds the defendants accountable for mischaracterizing acupuncture as a surgical procedure in order to dishonestly obtain millions of dollars from Medicare and the Federal Employees Health Benefit Program,” said United States Attorney Peace.  “Working with our partners at the Department of Health and Human Services Office of the Inspector General and the Office of Personnel Management, we identified the false claims that enabled our Office to negotiate resolutions that resulted in a significant recovery of taxpayer dollars.”

“Medical professionals are expected to bill taxpayer funded health care programs correctly to ensure that they remain solvent and available to those that need their services,” stated HHS-OIG Special Agent-in-Charge Lampert.  “Along with our law enforcement partners, this settlement affirms our commitment to ensuring that individuals and entities that bill federal health care programs do so in an honest manner.”

“Today’s settlement reminds all providers that if they submit false claims, they will be held accountable,” stated OPM Deputy Inspector General Vint.

The defendants treated patients with electro-acupuncture devices called P-Stim and NeuroStim/NSS (“NSS”).  P-Stim and NSS procedures transmit electrical pulses through needles placed just under the skin on a patient’s ear.  Both treatments are considered acupuncture under Medicare and Federal Employees Health Benefit Program (“FEHBP”) guidelines and are therefore ineligible for reimbursement by the government.

From January 2012 through April 2017, the IPMC surgery centers and medical offices submitted claims to Medicare and FEHBP for P-Stim and NSS treatment and associated administration of anesthesia.  In submitting the claims, the defendants used a billing code that mischaracterized the acupuncture treatment as a surgical implantation of a neurostimulator.

In addition to paying the civil settlement, Dr. Poonia, New Jersey Interventional Pain Management Center, PC; Advanced Interventional Pain Management Center, LLC; Global Anesthesia Group, LLC; Springfield Surgery Center, LLC; Park Avenue Surgery Center, LLC; and Endo Surgi Center of Old Bridge, LLC, have agreed to enter into an Integrity Agreement with the HHS-OIG.

The Integrity Agreement requires that these entities and their owners implement specific measures intended to prevent future health care fraud and address evolving compliance risks.  These measures include training for staff on applicable health care fraud laws and submitting to a claims review conducted by an Independent Review Organization to ensure compliance with Medicare billing requirements.

The allegations were brought to the government’s attention through the filing of a complaint captioned United States ex rel. Anu Doddapaneni and Christian Reyes v. Amit Poonia, MD., New Jersey Interventional Pain Management Center, P.C. et al., 18-CV-5214 pursuant to the qui tam provisions of the False Claims Act.

Under the Act, private citizens can bring suit on behalf of the United States and share in any recovery.  The claims resolved by the settlement are allegations only; there has been no determination of liability, nor a concession by the United States that its claims are not well founded.

The government’s case was handled by Assistant U.S. Attorney Jolie Apicella of the Office’s Civil Division with assistance from Civil Investigator Joseph Giambalvo.

The Defendants:

Dr. Amit Poonia, M.D.

New Jersey Interventional Pain Management Center P.C.

New York Interventional Pain Management P.C.

Advanced Interventional Pain Management Center LLC

Interventional Pain Management & Ortho Spine Center LLC

Interventional Pain Management Center P.C.

Advanced Multispecialty Group

Central Jersey Pain Institute LLC

Global Anesthesia Group LLC

Park Avenue Surgery Center LLC

Springfield Surgery Center LLC

Endo Surgi Center of Old Bridge LLC

Main Avenue Clifton Surgery Center LLC

 

Premium Interventional Pain Management

Synergy Medical Laboratories Inc.

Universal Transportation Service LLC

E.D.N.Y. Docket No. 18-CV-5214 (ENV)

SOURCE: USDOJ.Today