Improper billing costs medical practice almost $2M; doctor pleads guilty in drug conspiracy

Gavel and flag in courtroom
Two cases of healthcare fraud were resolved against a medical practice and doctor. (Getty/AlexStar)

Two cases involving healthcare fraud were resolved Tuesday when an anesthesiology practice in New York agreed to pay almost $2 million to resolve claims that it improperly billed for services, and a Detroit-area doctor pleaded guilty to fraud conspiracy for his role in a $19 million Medicare fraud scheme.

The New York practice, which specializes in spine and back procedures, billed Medicare for moderate sedation services that require a physician to spend at least 16 minutes face-to-face with the patient, the U.S. Attorney’s office in Syracuse said in an announcement Tuesday.

The claims were made against New York Spine & Wellness Center, where prosecutors said the practice routinely billed for services when doctors spent less than the required time with patients. The practice, which has three locations in the Syracuse area, agreed to pay more than $1.9 million. The U.S. Attorney’s office said that ensured more than $660,000 will be returned to the state’s Medicaid program.

Free Daily Newsletter

Like this story? Subscribe to FierceHealthcare!

The healthcare sector remains in flux as policy, regulation, technology and trends shape the market. FierceHealthcare subscribers rely on our suite of newsletters as their must-read source for the latest news, analysis and data impacting their world. Sign up today to get healthcare news and updates delivered to your inbox and read on the go.

The improper billing stopped after the practice was contacted by the U.S. Attorney’s office and the practice cooperated with investigators, officials said. A private insurance company rejected two of the practice’s claims for moderate sedation services for not satisfying the 16-minute rule and conducted an audit, but prosecutors said the practice continued to bill for services without meeting the time requirement.

“Providers should have policies and procedures in place to ensure that they are familiar with applicable billing requirements before submitting claims,” said Acting U.S. Attorney Grant C. Jaquith.

In Michigan, Abdul Haq, M.D., 72, of Ypsilanti, pleaded guilty to one count of conspiracy to commit healthcare fraud, according to the Department of Justice. His sentencing is scheduled for next May.

As part of his guilty plea, Haq admitted that he conspired with the owner of the Tri-County Network, Mashiyat Rashid, and his co-defendants to prescribe medically unnecessary controlled substances to Medicare patients, many of whom were addicted to narcotics, prosecutors said.

As part of the conspiracy, Haq admitted Rashid also directed him and other physicians to require patients undergo medically unnecessary facet joint injections to obtain the prescriptions for controlled substances. The others indicted in the case are awaiting trial.

Suggested Articles

Humana filed suit Friday against more than a dozen generic drugmakers alleging the companies engaged in price fixing.

Medicare Advantage open enrollment kicked off last week, and insurers are taking new approaches to marketing a slate of supplemental benefit options. 

Health IT company Cerner announced a definitive agreement to acquire IT consulting and engineering firm AbleVets as a wholly owned subsidiary.