JACKSONVILLE, Fla. – The United States has settled allegations that a Jacksonville-based dermatology practice knowingly billed the government for services that were cosmetic in nature and not medically necessary, as well as "up-coded" certain bills to receive higher than allowed reimbursement, U.S. attorneys said.
The allegations resolved included liability under the False Claims Act.
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The government announced Tuesday that it has reached a settlement with Coastal Dermatology and the physician who owned the practice, Dr. Sanjiva Goyal.
In reaching the settlement, the U.S. and dermatology practice resolved allegations that from Jan. 1, 2009, until April 2014 Goyal operated a dermatology practice that routinely had a practice of billing for cosmetic dermatological procedures, billing for services when all the Medicare and TRICARE requirements were not established and billing for services at a higher rate of reimbursement than appropriate, authorities said.
The government agreed to accept $787,814 to resolve these allegations, according to U.S. attorneys.
The settlement involved false claims submitted to both the Medicare and TRICARE programs. U.S. attorneys said this case was developed by proactively mining health care reimbursement data.
In mining through the data, Coastal Dermatology was identified as a top biller of procedures related to skin lesion removal procedures and removal of inflamed seborrheic keratoses, authorities said.
Among the 3,814 TRICARE-participating dermatologists in the south region, Coastal Dermatology was No. 1 in terms of billings for lesion removals, according to U.S. attorneys.
"The United States Attorney's Office is committed to taking the steps necessary to protect Medicare, TRICARE and other federal health care programs from fraud," said U.S. Attorney A. Lee Bentley. "By bringing FCA cases such as this, we hope to recover funds obtained through the fraud and deter others from attempting similar schemes."
"Patients unable to receive necessary medical care suffer the cost of Medicare fraud when those funds are purposely stolen and diverted to pay for uncovered voluntary procedures," said special agent in charge Derrick Jackson, of the U.S. Department of Health and Human Services Office of Inspector General. "We will continue to work with our law enforcement partners to protect the integrity of entitlement programs like Medicare."
"This settlement highlights the commitment of the Defense Criminal Investigative Service and its law enforcement partners to protect the integrity of the Department of Defense health care program," said special agent in charge John F. Khin, Southeast Field Office. "DCIS aggressively investigates health care providers that defraud the DoD, to preserve American taxpayer dollars intended to care for our Warfighters, their family members and military retirees."