A New Jersey pain clinic, Pain Specialists, P.A., with locations in Northfield, Vineland, and Cape May Courthouse, has admitted to overbilling insurance companies for services. This was announced by U.S. Attorney John Giordano.
The clinic pleaded guilty to health care fraud before U.S. District Judge Karen M. Williams and agreed to a civil settlement with the United States regarding allegations of violating the False Claims Act.
Documents filed in the case reveal that between November 2015 and January 2020, Pain Specialists used the National Provider Identifier (NPI) number of its owner, a physician specializing in anesthesia and pain management referred to as "Individual-1," to bill Medicare, Medicaid, and private insurance plans. These bills were for services requiring Individual-1's presence or supervision while he was traveling and not present at the clinic. The clinic received approximately $58,365.26 under these circumstances.
Furthermore, between January 2014 and November 2020, Pain Specialists allegedly listed a physician as the rendering provider for services actually provided by non-physician practitioners without a physician present. This violated Medicare’s "incident-to billing" requirements and Medicaid's billing regulations.
Pain Specialists has agreed to pay criminal restitution of $58,365.26, a criminal fine of $81,711.36, and a civil settlement of $240,000. The claims resolved by this settlement are allegations only; no liability determination has been made.
U.S. Attorney Giordano credited several agencies for their roles in investigating the case: special agents from the U.S. Department of Health and Human Services' Office of Inspector General; FBI Atlantic City Resident Agency; Healthcare Fraud Task Force; and U.S. Drug Enforcement Administration's New Jersey Division.
The government is represented by Assistant U.S. Attorneys Daniel A. Friedman and Susan Pappy along with Trial Attorney Daniel Meyler from the Department of Justice’s Civil Division.
Defense counsel for Pain Specialists is Riza I. Dagli Esq., based in Roseland, New Jersey.