Acting United States Attorney Lisa G. Johnston has announced a resolution concerning allegations against Med-Surg Physician Group Inc. and its owner Oluyemisi Sangodeyi, M.D. They will pay $152,382.70 to settle claims of violating the federal False Claims Act. The accusations stem from submitting false payment claims to Medicare and Medicaid.
Med-Surg Physician Group, based in Beckley, West Virginia, offers general internal medicine services and medication-assisted treatment for substance use disorders. An analysis identified unusual billing practices for telehealth services, specifically with HCPCS procedure code Q3014, meant for facilities connecting patients to outside providers. Federal regulations mandate that only an originating site can bill for this fee.
Investigators found Med-Surg submitted claims using the Q3014 code for home-based telehealth visits, against federal regulations that the home cannot be billed as an originating site. The West Virginia Bureau for Medical Services further clarified this in a March 2020 letter. Between March 2020 and January 2021, Med-Surg's claims resulted in $76,191.35 being inappropriately received from Medicare and Medicaid.
Acting U.S. Attorney Johnston remarked, "Dr. Sangodeyi and Med-Surg repeatedly billed for fees they knew they were not entitled to, at the expense of the American taxpayer." She credited the resolution to investigative work by the U.S. Department of Health and Human Services-Office of the Inspector General (HHS-OIG) and the West Virginia Attorney General’s Medicaid Fraud Control Unit (MFCU), along with other contributors.
Maureen R. Dixon from the HHS-OIG emphasized the importance of accurately submitting claims for federal health care programs. West Virginia Attorney General JB McCuskey expressed commitment to ensuring Medicaid and Medicare funds are used appropriately, stating, "Many people rely on these programs and we, with our partners, will continue to work to protect taxpayer dollars."
The United States Attorney’s Health Care Fraud Task Force involves collaboration across various federal, state, and local agencies to address fraud issues affecting public health care programs.
Further details are available on the U.S. Attorney’s Office for the Southern District of West Virginia website.