Watertown medical practice to pay large fine for improper Medicare billing

North Country Neurology
North Country Neurology(WWNY)
Published: Aug. 3, 2022 at 11:24 AM EDT
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WATERTOWN, New York (WWNY) - A Watertown neurological practice has admitted to improperly billing the federal government for patients’ health care.

Officials with the Department of Justice’s Northern District of New York say North Country Neurology has agreed to pay $850,000 for, in part, submitting claims to Medicare for procedures that it billed at rates as if a physician performed the procedure.

Instead, says U.S. Attorney Carla Freedman, the procedures were performed by a physician’s assistant. That work is billed to Medicare at a lower rate.

“While North Country Neurology will pay a steep price for submitting false claims for payment to Medicare,” she said, “I commend the practice and its management for accepting responsibility for its past actions and for implementing forward-looking compliance measures in response to our investigation to assure systems are in place to facilitate and promote ethical and legal conduct in the future.”

Officials say the practice admits its compliance procedures were inadequate and that it hired a third-party consultant as soon as it learned of the government’s investigation.

“We realized some mistakes were made, and we’ll own up to them by paying the fine,” a statement from North Country Neurology said. “Additionally, we’ve hired outside assistance and the mistakes have been restituted. We’ve been in the North Country for 30 years, take pride in helping our patients, and will continue to be here for them and our dedicated staff.”

North Country Neurology admitted it submitted 120 claims from September 2015 through June 2019 that said a physician provided the service even though one was not in the room. Medicare allows a practice to say a physician performed the procedure if a physician’s assistant provided the service under a doctor’s direct supervision.

If a physician is not present, the procedure is billed at a lower rate.

Freedman says the practice also billed Medicare for the drug Botox, which other insurers had already paid for. Officials say this happened 761 times from March 2015 through February 2021. Officials say the cost of the drug is included in what Medicare pays for the procedure to administer it.

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