12 September 2023- Frederick Oncology and Hematology Associates, P.C., a former medical practice located in Frederick, Maryland, have paid the United States $850,949 to settle allegations that Frederick Oncology and Hematology Associates, P.C. (“FOHA”) submitted inappropriate claims to the United States for evaluation and management services.
The settlement agreement was announced today by United States Attorney for the District of Maryland Erek Barron, Special Agent in Charge Maureen Dixon of the Office of Inspector General for the Department of Health and Human Services (“HHS-OIG”), Special Agent in Charge Christopher Dillard of Defense Criminal Investigative Services (“DCIS”) Mid-Atlantic Field Office, and Conrad Quarles, Deputy Assistant Inspector General for Investigations, Office of Personnel Management, Office of Inspector General (OPM-OIG).
“It is fundamental that a medical provider accurately bill for services that are actually provided,” said United States Attorney Erek L. Barron. “The United States Attorney’s Office is committed to recovering monies for the federal healthcare programs and will hold practices and individuals accountable for their actions,” said Barron.
“Accurately billing for services provided to Medicare beneficiaries is required of all health care providers,” said Maureen R. Dixon, Special Agent in Charge for the U.S. Department of Health, and Human Services, Office of the Inspector General. “HHS-OIG will continue to work with our law enforcement partners to investigative allegations of fraud in federal health care programs.”
“This settlement demonstrates DCIS’ commitment to investigate health care providers who take advantage of TRICARE for personal enrichment,” said Special Agent in Charge Christopher W. Dillard, DCIS Mid-Atlantic Field Office. “DCIS proudly stands with our investigative law enforcement partners to root out fraud, waste and abuse.”
According to the settlement agreement, from January 1, 2013, to November 1, 2017, FOHA improperly submitted claims for evaluation and management using a code modifier that is only appropriate when there is a separate and distinct evaluation and management service on the same day as a procedure or other service being performed on a patient. FOHA submitted and was paid for those improperly billed claims when FOHA did not perform a separate and distinct evaluation and management. Additionally, FOHA improperly submitted claims from January 1, 2013, to November 1, 2017, under the billing number of the patient’s physician rather than the non-physician provider who treated the patient in the physician’s temporary absence.
The civil settlement reached by the U.S. Attorney’s Office for the District of Maryland arose from an initiative inside the U.S. Attorney’s Office, which involves the use of dedicated resources and personnel to review Medicare billing data. The review of that data has enabled the United States Attorney’s Office to identify areas of concern where it appears that billing irregularities may have taken place. Partnering with the effected agencies, the United States Attorney’s Office has developed the ability to investigate these billing irregularities.
The claims resolved by this settlement are allegations only, and there has been no determination of liability.
U.S. Attorney Erek L. Barron commended the HHS-OIG, DCIS, and OPM-OIG for their work in the investigation. The case was handled by Assistant United States Attorney Thomas Corcoran.