Columbus, Ohio - Comprehensive Pain Management Institute and its owner, Leon Margolin, M.D., have agreed to pay the United States $650,000 to resolve False Claims Act allegations that they knowingly billed Medicare for nerve conduction studies and alcohol/substance abuse assessments and interventions (SBIRT) that were medically unnecessary or not provided as billed, the Justice Department announced today. Margolin is a pain management physician in Columbus, Ohio.
“Billing Medicare for unnecessary services undermines the integrity of this important federal healthcare program and squanders taxpayer funds,” said Assistant Attorney General Jody Hunt of the Department of Justice’s Civil Division. “The Department will continue to work with its law enforcement partners to protect Medicare and its beneficiaries.”
Nerve conduction studies are used to measure how fast an electrical impulse moves through a person’s nerve. Electromyography is the study and recording of electrical activity in a person’s muscles. This testing is invasive in that it requires needle electrode insertion and adjustment at multiple sites. Performed together, the tests identify the presence and location of diseases that damage nerves and muscles. When a nerve conduction study is performed alone, the results can often be misleading, and it is considered medically unnecessary, except in limited circumstances not present here. SBIRT is an early intervention targeting those with substance abuse to provide effective strategies prior to the need for more extensive treatment. The government alleged that Margolin and his clinic billed Medicare for nerve conduction studies for patients who did not need them and without performing electromyography and for alcohol and/or substance assessments that were not necessary because the patients had no history of drug or alcohol abuse or where the services were not provided as billed.
“Attempting to make a profit by knowingly submitting false claims to Medicare will cost you in the end,” said U.S. Attorney David M. DeVillers of the Southern Disitrict of Ohio. “The U.S. Attorney’s Office remains committed to pursuing improper billing practices by doctors and other medical providers, and will hold them to their obligation to treat Medicare beneficiaries in an ethical manner, and request reimbursement from Medicare in accordance with all applicable rules and regulations.”
The allegations resolved by today’s settlement were identified by a government investigation that arose out of a critical analysis of Medicare claims data. The government’s settlement in this matter illustrates its emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement, can be reported to the Department of Health and Human Services, at 800-HHS-TIPS (800-447-8477).
The matter was investigated by the Civil Division’s Commercial Litigation Branch, the U.S. Attorney’s Office for the Southern District of Ohio, and the Department of Health and Human Services Office of Inspector General.
The claims asserted against this defendant are allegations only, and there has been no determination of liability.