A handful of medical clinics and their owners agreed last week to pay to the Federal government over $7.1 million to put to bed claims that they knowingly billed Medicare for a knee pain procedure and related medical devices that were medically unnecessary.
Per federal prosecutors, seven knee pain clinics and the individuals that owned them made a practice of offering viscosupplementation injections as a treatment for osteoarthritis in the knee joint to Medicare beneficiaries for whom such a treatment was medically unnecessary. Upon providing the treatment, prosecutors say the defendants also provided those Medicare beneficiaries with knee braces that were also medically unnecessary. The defendants then billed both the treatments and the braces to Medicare.
In addition to selling medically-unnecessary treatments and braces for knee pain to Medicare beneficiaries, investigators say the defendants used a wide array of viscosupplement brands one after another despite a lack of clinical support, and used discount viscosupplement brands from overseas.
The clinics and their owners agreed to pay to the Federal government over $7.1 million to settle the allegations against their clinics, which are located in Phoenix, Arizona; San Diego, California; Lexington, Kentucky; Wall Township, New Jersey; Dallas, Texas; and San Antonio, Texas. In addition, the clinics agreed to participate in a Corporate Integrity Agreement (CIA) with the Department of Health and Human Services Office of Inspector General, which will require implementation of comprehensive compliance controls and annual clinical claims reviews by an Independent Review Organization.
The claims in question arose from the federal False Claims Act (a/k/a “Lincoln’s Law”) whistleblower, or qui tam provisions, which allow individuals with knowledge of wrongdoing to file suit and allow Federal prosecutors to take over should they find the suit to have merit.
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