KNOXVILLE, Tenn. – The United States Attorney’s Office today announced that Align Health and Holistic Medical Center, Inc. and Align Health Management, Inc., (collectively “Align”), Eric Anderson, PA d / b / a Anderson Chiropractic Clinic (“Anderson Chiropractic”), their owners and a former employee agreed to pay $ 163,400 to resolve allegations that they knowingly and improperly billed Medicare for electro-acupuncture using pacing devices peri-auricular in violation of the False Claims Act (“FCA”).
Align and Anderson Chiropractic are outpatient clinics located in Maryville, Tennessee that provide medical and chiropractic services for the treatment of pain. According to claims made by the United States in the settlement agreement, between September 2016 and March 2019, Align and Anderson Chiropractic regularly submitted, or caused to be submitted, false claims to Medicare for the installation of electrical appliances. -acupuncture on patients. The placement of these devices was incorrectly billed under code L8679, which resulted in clinics receiving Medicare payments to which they were not entitled.
L8679 is a billing code for “implantable neurostimulator, pulse generator” devices that are surgically implanted into the central nervous system or targeted peripheral nerves through procedures typically performed by a surgeon in an operating room. However, the United States contends that Align and Anderson Chiropractic falsely billed Medicare under L8679 for electro-acupuncture devices that they knew had not been surgically implanted in their patients and for procedures that did not. did not involve anesthesia or did not take place in an operating room. The underlying services for which Align and Anderson Chiropractic submitted claims L8679 involved the application of a device used for electro-acupuncture. Common brand names for this device include P-Stim, Stivax, NeuroStim, ANSiStim, E-Pulse, and NSS-2 Bridge. Electro-acupuncture devices were applied by inserting needles into patients’ ears and gluing the devices behind their ears with adhesive. Medicare does not reimburse electro-acupuncture devices billed as neurostimulators and has not reimbursed acupuncture at all during the covered driving period.
In addition to paying the civil settlement, which was based on the parties’ ability to pay, Align, Anderson Chiropractic and their owners agreed to enter into an Integrity Agreement (“IA”) with the Department’s Office of Inspector General. of Health and Social Services (“OIG-HHS”). The IA requires, among other things, that Align, Anderson Chiropractic and their owners implement specific measures to prevent future healthcare fraud and address evolving compliance risks. These measures include training staff on applicable healthcare fraud laws and submitting to a claims review conducted by an independent review body to ensure compliance with Medicare billing requirements.
This investigation is the result of a coordinated effort between the United States Attorney’s Office for the Eastern District of Tennessee, OIG-HHS, and the Southeastern Unified Program Integrity Contractor (“UPIC”).
Assistant US Attorney Joseph C. Rodriguez represented the United States.
The claims settled by this agreement are only allegations, and there has been no determination of liability.