Medical Group to Pay $4.36 Million to Resolve Upcoding Claims

Nephrology Physician Practice Group and Dialysis Centers Accused of Overbilling Medicare

Apex Medical Group, P.C., d.b.a. Nephrology Consultants, a Tennsessee-based nephrology physician practice group, has agreed to pay $4.36 million to settle alleged violations of the federal False Claims Act, the Tennessee Medicaid False Claims Act, and other federal and state laws and regulations.

The U.S. Attorney for the Eastern District of Tennessee asserted that the group submitted numerous false and fraudulent claims to government health programs, including Medicare and TennCare, for payment through a pattern of upcoding for various physician services.  “Upcoding” refers to using billing codes that reflect a more severe illness than actually existed or a more expensive treatment than was provided.

The government also contended that six dialysis clinics owned by Extracorporeal Technologies, Inc., and Fort Sanders Kidney Center, Inc., improperly submitted inaccurate claims to the same government health programs for a variety of dialysis services.

As part of the overall settlement, Apex and Dr. Naseemul Siddiqi entered into a comprehensive five-year Integrity Agreement with the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS).  The OIG negotiates integrity agreements with health care providers to ensure future compliance with federal health care benefit program requirements.  In exchange, the OIG agrees not to seek their exclusion from participation in Medicare, Medicaid, or other Federal health care programs.

Click here to see the government's press release on the settlement.

John Howley, Esq.
New York, New York

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