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Medicare Fraudsters Beware; DOJ May Be Reviewing Your Billing Data

Posted  May 15, 2018

By the C|C Whistleblower Lawyer Team

Maryland physician Sureshkumar Muttath agreed to pay more than $1.5 million to settle claims he violated the False Claims Act by submitting claims to Medicare for medically unnecessary autonomic nervous function tests and neurobehavioral status exams.  The settlement originated under DOJ’s new initiative of tracking irregularities in Medicare billing data.  See DOJ Press Release.

According to the government, the nervous function tests Dr. Muttath conducted are for relatively uncommon disorders, should be done only after a clinician has some reason to suspect the condition, and should be administered by clinicians with the requisite training and expertise to interpret the tests.  The government alleged the tests Dr. Muttath performed were not medically necessary and otherwise excluded from coverage because he did not have the necessary equipment, he did not have the proper training, and the patients had not been properly diagnosed.  With regard to the neurobehavioral status exams, the government claimed Dr. Muttath misrepresented the services he actually performed, not spending the required amount of time with the patient which would have allowed the full assessment he was claiming to make of the patients’ thinking, reasoning, and judgment.

What is perhaps most notable about this enforcement proceeding is that it originated under a new DOJ initiative to track Medicare billing data.  The program is designed to identify areas of concerns, or as in this case, specific health care providers of concern, because of abnormalities in their Medicare billing data.  In particular, the government is looking for health care providers that have a disproportionately high level of billing for certain practices or procedures.  This is an investigatory tool we can expect to see with ever-increasing frequency with electronic advances in billing and medical record keeping.  So doctors, clinics, medical practices, hospitals and other health care providers beware.  Be careful what you bill for.  The government is watching.

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud,


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