(STL.News) – United States Attorney Matthew D. Krueger announced today that L.M.G., Inc., which does business as TMJ & Orofacial Pain Treatment Centers of Wisconsin, agreed to pay $1,000,000 to the United States to resolve allegations that TMJ & Orofacial Pain Treatment Centers of Wisconsin submitted false claims to Medicare and TRICARE for oral appliances used to treat temporomandibular joint disorder.
TMJ & Orofacial Pain Treatment Centers of Wisconsin operates four clinics in the Milwaukee area and specializes in the treatment of temporomandibular joint disorder. In their treatment of temporomandibular joint disorder, TMJ & Orofacial Pain Treatment Centers of Wisconsin and its dentists often prescribe oral appliances to stabilize or reposition the patient’s jaw. The United States alleges that TMJ & Orofacial Pain Treatment Centers of Wisconsin and its dentists did not fabricate the appliances, but rather purchased them from an outside laboratory that fabricated the appliances. The United States further alleges that TMJ & Orofacial Pain Treatment Centers of Wisconsin falsely billed Medicare and TRICARE for oral appliances under billing codes applicable to expensive prosthetic devices fabricated by surgeons, rather than other lower paying billing codes applicable to appliances fabricated by an outside laboratory.
“Medical providers cannot misrepresent the services they provide in order to increase their billings to government insurance programs,” stated United States Attorney Krueger. “This settlement makes the Medicare and TRICARE programs whole and sends a message to medical providers that false billings will not be tolerated.”
“When TMJ & Orofacial Pain Treatment Centers of Wisconsin submitted claims to Medicare, it promised that it actually provided the services it billed for. This settlement holds TMJ & Orofacial Pain Treatment Centers of Wisconsin to account for its promises,” said Lamont Pugh III, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General – Chicago Region. “The OIG will continue to work with our federal, state and local partners to protect vital taxpayer dollars.”
The government’s investigation resulted from a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. Accordingly, the whistleblower will receive a share of the settlement amount. As part of the settlement, the government and the whistleblower will ask the district court to dismiss the whistleblower’s qui tam complaint.
Assistant United States Attorney Michael Carter represented the government in this matter, and the OIG and the Defense Criminal Investigative Service assisted in the investigation. The settlement agreement states allegations only; the defendants do not admit liability for the allegations.