The U.S. Attorneyâ€™s Office for the Northern District of Georgia announced that it has reached a settlement with dermatologists Margaret Kopchick, M.D., and Russell Burken, M.D., and their practice group, Toccoa Clinic Medical Associates, who agreed collectively to pay $1.9 million to settle claims that they violated the False Claims Act by billing Medicare for evaluation and management (E&M) services that were not permitted by Medicare rules.
â€œPhysicians and practice groups are expected to bill Medicare for the costs of the services they provide.Â However, when they improperly bill for those services, it affects those who depend on Medicare by taking available dollars away from the program,â€ said U.S. Attorney John Horn.Â â€œThose who inflate their Medicare billings can expect recovery of any overpayments, as well as significant penalties under the False Claims Act.â€
â€œThe improper billing of evaluation and management services cost the taxpayers millions of dollars each year and drain the Medicare Trust Fund,â€ said Derrick L. Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG) for the Atlanta region.Â â€œThe OIG and the U.S. Attorneyâ€™s Office will continue to hold health care providers like these responsible for improper claims.â€
The civil settlement resolves the United Statesâ€™ investigation into Drs. Burken and Kopchickâ€™s billing for E&M services on the same day as a procedure. Providers are not permitted to bill both E&M services and a procedure on the same day under the Medicare programâ€™s regulations unless a significant, separately identifiable service has been performed. In addition, where a significant, separately identifiable service has been performed, providers must bill the appropriate level of E&M service. More complex E&M services are reimbursed at higher rates. Here, the United States alleged that Drs. Burken and Kopchick billed for E&M services along with procedures where no significant and separately identifiable service was performed, and upcoded E&M services to higher levels than were appropriate, leading to overpayments by Medicare.
HHS-OIG has identified the inappropriate billing of E&M services as a national issue costing taxpayers billions of dollars.Â
This resolution is part of the governmentâ€™s emphasis on combating health care fraud under the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by the Secretary of the Department of Health and Human Services in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act. Since January 2009, the Justice Department recovered more than $27.4 billion through False Claims Act cases, with more than $17.4 billion of that amount recovered in cases involving fraud against federal health care programs.
This case was investigated by the U.S. Attorneyâ€™s Office for the Northern District of Georgia and the U.S. Department of Health and Human Services, Office of Inspector General.
Assistant United States Attorney Emily Shingler reached the civil settlement.
The claims settled by the settlement agreement are allegations only; there has been no determination of liability.