Pa. physicians, health facilities settle $690k fraud claim

Allentown, Pa.-based Lehigh Valley Pain Management, three physicians and a number of affiliated clinics have agreed to pay approximately $690,000 to the federal government to resolve allegations they improperly billed government agencies, according to the Department of Justice.

Allegations against the physicians and healthcare facilities were brought under the qui tam provision of the False Claims Act.  

The suit alleges defendants improperly assigned billing codes to services to indicate the presence of a supervising physician when physicians were away or incapable of performing their duties, according to the report. Billing services as "incident to" a physician's supervision has a higher reimbursement rate than billing those same services without physician supervision.

The complaint alleges the defendants submitted false billing claims to Medicare, Federal Employees Health Benefits and the U.S. Department of Labor's Office of Worker's Compensation during the period July 1, 2007 through Dec. 31, 2013.  

As part of the settlement, the defendants agreed to not submit claims to federal payers for any services performed by non-physicians for the next 30 months.

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