“When that obligation is violated, government health care programs – and American taxpayers – pay the price. Department of Health and Human Services, Office of Inspector General. “Healthcare providers are expected to closely follow Medicare rules and bill properly - nothing more, nothing less,” said Special Agent in Charge Phillip M. This office is committed to vigorously pursuing health care providers who submit false or fraudulent claims to federal health care programs.” Providers who participate in government programs must only bill for medically necessary services, and must accurately bill for the services provided. “Medical services billed to Medicare and Medicaid must be provided based on each patient’s individual medical needs. “Depriving Medicare and Medicaid programs of federal funds that have been set aside for the care and treatment of beneficiaries is disgraceful,” said U.S. The government alleges that between April 1, 2020, and December 31, 2020, on the same dates that patients received COVID-19 tests, DOCS and Sidana submitted claims for moderately complex “level 3” E&M services, when those level 3 office visits were not in fact provided. Instead, the services were actually performed by lower-level providers, who typically receive a lower reimbursement rate from Medicare and Medicaid for such services.įinally, the government contends that when administering tests for COVID, DOCS and Sidana improperly billed Medicare and Connecticut Medicaid for certain evaluation and management (“E&M”) services, commonly referred to as office visits. The government also alleges that between January 1, 2014, and January 1, 2019, DOCS and Sidana submitted claims for medical services performed by Sidana on dates of service when he was traveling internationally and did not perform or supervise the services. The allegations also involve claims to Medicare and Medicaid for medically unnecessary annual re-testing of allergy patients between January 1, 2014, and November 11, 2018. The government alleges that between October 1, 2016, and September 30, 2017, DOCS and Sidana submitted false claims to Medicare and Medicaid for immunotherapy services that were not medically necessary, and were not directly supervised by a physician. In early 2014, DOCS and Sidana started providing allergy testing and treatment services to their patients. Direct supervision requires the supervising physician to be present in the same office suite, and immediately available to render assistance if needed.
Some services also have supervision requirements, and allergy tests and the preparation of allergy immunotherapy must be directly supervised by a physician. Medicare and Connecticut Medicaid pay only for services or items that are medically necessary.
Sidana is a physician who specializes in pulmonology and is the owner and Chief Executive Officer of DOCS, a medical practice with more than 20 facilities throughout Connecticut that offers a variety of services to its patients, including primary and urgent care, allergy testing and treatment, and COVID testing. The agreement also resolves allegations that Sidana and DOCS improperly billed for certain office visits associated with COVID-19 tests. (doing business as Docs Medical), DOCS MEDICAL INC., DOCS URGENT CARE LLP, LUNG DOCS OF CT, P.C., EPIC FAMILY PHYSICIANS, LLP, and CONTINUUM MEDICAL GROUP, LLC (collectively, “DOCS”), have entered into a civil settlement agreement with the federal and state governments in which they will pay a total of $4,267,950.21 to resolve allegations that they submitted false claims for payment to Medicare and the Connecticut Medicaid program for medically unnecessary allergy services, unsupervised allergy services, and services improperly billed as though provided by Sidana. Department of Health and Human Services, Office of the Inspector General, today announced that JASDEEP SIDANA, M.D. Vanessa Roberts Avery, United States Attorney for the District of Connecticut, and Phillip Coyne, Special Agent in Charge for the U.S.
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