Saturday, April 16, 2016

Florida Pain Medicine Clinic and its Owners Agree to Settle Qui Tam Case Involving Allegedly Medically Unnecessary Nerve Conduction Velocity Tests

Nerve conduction studies (NCS) or nerve conduction velocity tests (NCV) have been a source of Medicare audits in California and Florida for years. Medical necessity is the usual basis for the audits but in this case, a billing employee brought a whistleblower lawsuit and the U.S. intervened.   

In a recent case, a civil qui tam case was settled on April 13, 2016 involving the billing of NCS procedures to Medicare and alleged violations of the False Claims Act. The case is United States ex rel. Gomez v. Florida Pain Medicine Associates, Inc., et al., Case No. 13-80856 CIV (S.D. Fla.).  

The allegations in the case were originally brought by Rosa Gomez under the qui tam, or whistleblower provisions of the False Claims Act. She sued Florida Pain Medicine Associates, Inc. (Florida Pain Medicine) and its owners, Drs. Bart Gatz, Alexis Renta, and Albert Rodriguez. Ms. Gomez had worked in Florida Pain Medicine’s billing department. The United States intervened in this case and took over primary responsibility for litigation. 

Ms. Gomez (and then the United States) alleged that patient records indicated that a substantial percentage of the NCSs that were performed at Florida Pain Medicine were medically unnecessary. It was alleged that the NCSs were often administered without an accompanying electromyography (EMG) test, thereby substantially decreasing the diagnostic value of the procedure. It was contended that this was especially true where the NCS was the sole basis for performing an epidural steroid injection. Florida Pain Medicine denied these allegations.

Ultimately, like many qui tam cases, the cases settled without any admission of liability. Florida Pain Medicine and its owners agreed to pay $1.1 million to resolve allegations that they violated the False Claims Act by billing Medicare for medically unnecessary nerve conduction studies (NCS).  The claims settled by the lawsuit are allegations only and there has been no determination of liability. Ms. Gomez will receive $242,000 as her share of the proceeds.

Attorney Note: One of the most important reasons for self-disclosure and compliance plans (including exit interviews) is to avoid the whistleblower lawsuits. In many cases, former employees are rushing to qui tam plaintiff attorneys to find grounds for filing cases. Although disclosure can seem painful and not necessary, the interest in employees seeking a payday in qui tam cases, even where the facts are weak, is an expensive and time consuming process. 

Posted by Tracy Green, Esq.
Contact: 213-233-2260


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