Longview clinic to reimburse Medicare after submitting dozens of false claims

Crime

LONGVIEW, Texas (KETK) – The Spinal Decompression Clinic of Texas in Longview has agreed to reimburse Medicare after allegedly submitting dozens of false claims from August 2018 to June 2019, according to federal prosecutors.

The U.S. Attorney for the Eastern District of Texas, Stephen J. Cox, said the Longview-based clinic will pay $330,898.00 to resolve liability.

“Falsely submitting claims for non-covered services robs from the Medicare program and thereby deprives those in need from vital resources,” Cox said. 

The clinic billed Medicare for the implantation of 41 neurostimulators, which is a surgical procedure and is reimbursed by federal healthcare programs. For this, the clinic received $117,051.15 in reimbursements from Medicare.

Cox, in a press release Tuesday, said the clinic did not perform those surgeries, but a less invasive acupuncture procedure called P-Stim. Medicare does not reimburse for acupuncture procedures, P-Stim included.

P-Stim is a temporary, single-use medical device that is affixed behind a patient’s ear using an adhesive. Needles are inserted into the ear and affixed using another adhesive. When it is activated, the device provides intermittent electrical pulses.

The device can be worn for four days before the batteries go out and it is thrown away. P-Stim is not applied through a surgery or with anesthesia and can be done in an office setting.

“When services provided are excluded from Medicare reimbursement, some providers may be tempted to falsely claim payment for covered treatments.  Such schemes, however, can result in hefty fines and prosecution,” said Miranda L. Bennett, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services.  “In coordination with our law enforcement partners, we will investigate and hold accountable entities that engage in these practices.”  

 This case was investigated by the U.S. Department of Health and Human Services of the Inspector General. Assistant U.S. Attorney Aimee M. Cooper handled the matter.

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