Chattanooga Clinic Agrees to Settle Medicare Fraud Case for Over $1 Million

Chattanooga Clinic Settles Medicare Fraud Allegations for Over $1 Million

In a significant turn of events for the medical community in Chattanooga, Apple Corporate Wellness, Inc., now known as Bryn Medical Center and Basket Medical PLLC, has agreed to a settlement totaling $1,148,598. This decision comes after the clinic faced allegations of knowingly and improperly billing Medicare for electro-acupuncture services in violation of the False Claims Act.

What Went Wrong?

So, what exactly happened? The allegations focus on a period between June 28, 2016, and June 19, 2017. During this time, it is claimed that Apple presented or caused to be presented false claims to Medicare for the placement of electro-acupuncture devices on patients. More specifically, they improperly billed these services using a coding system known as Healthcare Common Procedure Coding System Code L8679.

This billing code is typically reserved for much more invasive procedures—namely, those involving “implantable neurostimulator, pulse generator” devices that are surgically implanted into the body, specifically in the central nervous system or targeted peripheral nerves. These procedures are usually performed by licensed surgeons in an operating room, complete with anesthesia, and not by a basic clinic applying electro-acupuncture, as Apple did.

How Was Electro-Acupuncture Misrepresented?

The real kicker here is that the devices Apple used for their electro-acupuncture treatments were not surgically implanted. Patients received treatment through non-invasive methods, which included placing needles into their ears and taping devices behind those ears using adhesive. Imagine that – what may seem like a simple and straightforward procedure led to a massive misunderstanding and misuse of medical billing practices.

It’s worth noting that during the covered dates, Medicare did not reimburse for acupuncture services, especially for devices that were billed incorrectly as neurostimulators. The clinic should have understood that their practices were not in compliance with regulations, yet they continued their billing practices as usual, leading to significant repercussions.

A Collaborative Investigation

The decision to settle didn’t come about in a vacuum. This investigation was the result of a collaborative effort between various entities, including the U.S. Attorney’s Office for the Eastern District of Tennessee and the Office of Inspector General of the U.S. Department of Health and Human Services. These organizations teamed up to examine the clinic’s practices closely, demonstrating the rigorous oversight that exists in the healthcare industry.

Assistant U.S. Attorney Joseph C. Rodriguez represented the United States in this case, emphasizing the need for accountability when it comes to healthcare billing practices.

The Importance of Compliance

Although this settlement addresses only allegations and there has been no formal determination of liability, it is a reminder of just how crucial compliance is in the healthcare industry. With rising medical costs and increasing scrutiny from regulatory bodies, clinics and hospitals must remain vigilant to avoid any unintended violations that could lead to hefty penalties or settlements.

As residents of Chattanooga, we can take this situation to heart. It serves as a reminder that when seeking medical care, we should always be aware of what services are being billed and whether those procedures align with what was performed or discussed with our healthcare providers. Knowledge is power, especially in a field as complex as healthcare!

Final Thoughts

As we reflect on these events, it’s crucial to keep the conversation going about healthcare practices in our community. While we trust our medical providers, understanding the systems in place, including billing practices, can help us all stay better informed about our health and well-being. Here’s hoping that Bryn Medical Center and other clinics take this as a learning opportunity for the future!