Facilitating 12,000 false claims costs chiropractor more than $15 million
We’ve all heard the admonition that if you didn’t code it, it didn’t happen. But what happens when it didn’t happen, but someone coded it anyway? Timothy Warren, a chiropractor in Wichita, Kansas, learned the hard way that his cost for facilitating violations of the False Claims Act is $15,270,066.
This was the amount of a recent default judgment against Warren and his company Titan Medical Compliance, LLC in a continuing U.S. Department of Justice (DOJ) national investigation into improper billing associated with P-Stim electro-acupuncture devices. The U.S. Attorney’s Office in the Eastern District of Pennsylvania sought a default judgment against Warren and Titan when they failed to respond after their attorneys withdrew. The default judgment involving approximately 12,000 false claims was announced in a November 3 press release.
Federal healthcare programs do not reimburse for P-Stim devices, also branded as ANSiStim, Stivax, NeuroStim, and NSS-2 Bridge, whether characterized as an electro-acupuncture device or as an implantable neuro-stimulator.
Warren, who began promoting himself as a medical reimbursement consultant and his company as a compliance consulting firm in 2014, falsely promoted these devices as reimbursable by Medicare and other federal insurers and gave providers instructions regarding which codes to bill.
The codes, which generated a high rate of reimbursement, were intended for legitimate, surgically implanted neurostimulators that manage chronic pain. In contrast, P-Stim may be applied without anesthesia in an office setting by staff with minimal training. Warren and his company knew that the devices were not reimbursable by federal healthcare programs but nonetheless continued to falsely promote their eligibility.
The DOJ has recovered tens of millions of dollars in cases against P-Stim providers, marketers, distributors, and coders during the last two years. “Even those who never applied P-Stim themselves can be held accountable for causing others to submit false claims through marketing and disseminating fraudulent coding advice,” U.S. Attorney Jacqueline C. Romero said in the press release. “If a scheme seems too good to be true, it probably is—and you should be wary.”