On Wednesday in the Southern District of Texas, the United States filed a complaint against a Houston chiropractor and her clinic, alleging that she has been operating a fraudulent insurance billing scheme and violating the False Claims Act (FCA).
The U.S. claimed that chiropractor, nurse practitioner, and manager Suhyun An, acting through Johnson Medical Group PLLC and Campbell Medical Group PLLC, knowingly used the incorrect billing code for percutaneous electrical stimulation devices, commonly known as p-stim devices, used to treat patients at Campbell Medical Clinic. Allegedly, defendant An used billing code L8679, which is a “very expensive code” meant for implantable neurostimulators, according to the complaint.
“Here, however, the devices were not ‘implantable’ and did not require surgery,” the complaint contended. “Rather, the devices were simply taped to a patient’s ear using an adhesive. The only things that went into a patient’s body were the electrodes that were inserted into the patient’s ear—barely penetrating the skin—and affixed using another adhesive.”
An purportedly paid a few hundred dollars for each device, but she received $6,000 or more in reimbursement for every claim she submitted, the complaint alleged. In total, she allegedly received more than $3.8 million in reimbursement across more than 600 Medicare claims and more than $50,000 across 31 TRICARE claims.
The U.S. claimed that the devices were just offering electric acupuncture, and such devices are not reimbursable through Medicare. These alleged false claims coupled with An “knowingly” submitting them add up to FCA violations, according to the complaint. The U.S. argued An should have known that these devices were not covered under Medicare because of how the devices function — adhesively — and because billing code L8679 explicitly applies to implantable neurostimulators. She also should have been tipped off by the disparity between the relatively low cost of the devices and how much she was being reimbursed, the complaint argued.
The complaint also cited an email communication from An to Timothy Warren, a “compliance consultant”:
“If I wanted to, we can prescribe a lot of pstim a week, I have fairly large medicare recipients in my office. But my goal is to fly under the audit radar,” an excerpt of the email read.
The U.S.’s formal causes of action against the defendants are FCA violations, common law fraud, payment by mistake of fact, and unjust enrichment.