Texas Healthcare Providers to Pay More than $1M in False Claims Case

June 11, 2021

Three separate Texas healthcare providers will pay a collective $1,056,340.50 to resolve liability under the False Claims Act for the alleged improper billing of electro-acupuncture devices, the U.S. Attorney’s Office for the Western District of Texas reported.

These providers – Ledger Foot & Ankle, P.A of Harker Heights, Superior Physical Medicine of Round Rock and Precision Spine and Pain Management of San Antonio – billed Medicare and/or TRICARE for the implantation of neuro-stimulators, a surgical procedure that usually requires an operating room and is reimbursable by federal healthcare programs. However, the procedure billed actually involved a non-surgical, non-invasive application of the devices that is non-reimbursable by federal healthcare programs, the U.S. Attorney’s Office said.

Between February 2018 and January 2020, Dr. Harold Ledger, DPM, of Harker Heights, through his practice, Ledger Foot & Ankle, P.A., billed Medicare for the application of ANSiStim devices to beneficiaries as though they were implantable neurostimulators. Certain Medicare beneficiaries were identified as also having TRICARE benefits that were further billed to the program as the secondary insurer.

Dr. Ledger will pay a total of $535,000.00 to resolve his liability under the False Claims Act.

Between December 2016 and September 2018, SPR Medical Group (formerly known as Atlas Medical Group), d/b/a Superior Physical Medicine, (Superior) billed Medicare for the application of ANSiStim and STIVAX devices as though they were implantable neurostimulators.

Following a Medicare audit of two neurostimulation procedures, Superior initiated a full repayment of the Medicare funds received for those two claims and conducted an internal audit of all claims. Superior self-disclosed claims improperly billed and has agreed to pay a total of $338,150.50 to resolve any potential liability under the False Claims Act.

Between March 1 and April 2019, Dr. Yurii Borshch, through his practice Precision Spine and Pain Management, billed Medicare for the application of ANSiStim devices to beneficiaries as though they were implantable neurostimulators.

During the pendency of the investigation and settlement negotiations, Dr. Borshch initiated refund payments to Medicare for the identified claims and paid a total of $183,190.00 to resolve potential liability under the False Claims Act.

The settled civil claims are allegations only and do not constitute admissions of liability by any of the identified practitioners.

These matters were investigated by the U.S. Department of Health and Human Services Office of the Inspector General. All three settlements were negotiated on behalf of the government by Assistant U.S. Attorney Erin M. Van De Walle.

Source: U.S. Attorney’s Office for the Western District of Texas

Topics Texas Claims Medical Professional Liability

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