Deeper Than the Headlines: When Podiatry is a Real Pain in the Foot

Uh-oh. Foot problems are turning into legal difficulties for a Michigan podiatrist and things are not looking good. Dr. Lawrence Young, D.P.M. was indicted last week for providing services that were not rendered or not medically necessary, concealing the submission of false and fraudulent claims to Medicare and receipt and transfer of fraud proceeds, and diverting fraud proceeds for his personal use and benefit. It’s cases like these that we can all learn from.

The court documents suggest that the investigation first arose from work done by the Zone Program Integrity Contractor or ZPIC. The ZPIC is a regional contractor charged with investigating fraud, waste and abuse in government healthcare programs such as Medicare. The FBI and HHS-OIG investigated the case, which was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan.  There was no mention of a qui tam relator or whistleblower.

Both of the clinics involved in the indictment, Dearborn Podiatric Surgeons and Georgetown Podiatric Surgeons, were run by Dr. Young in Michigan.

The particular services listed in the indictment are common procedures for foot care, and those who are familiar with podiatry services will recognize the CPT codes as outlined in the indictment:

CPT Codes 28232 and 28234

“CPT Codes 28232 and 28234 are procedures often performed to repair hammer toes. A small incision is made on the crease of the toe on the bottom of the foot exposing the tendon. The tendon is released from its attachment site allowing the toe to extend. The incision is closed with sutures and a soft dressing is applied.”

CPT Codes 29580

“CPT Code 29580 is the application of an Unna Boot. An Unna boot is a dressing typically used to control leg swelling after surgery or when a patient has poor lower leg circulation. The physician evenly applies a dressing (typically from top of foot to just below the knee) that contains a zinc oxide, gelatin, and glycerin paste. Additional bandages and paste are applied over the first layer to provide rigidity and reinforcement. This particular dressing is typically replaced by a physician or member of his/her staff at least once a week.”

CPT Codes 20605

“CPT Code 20605 requires a needle to be inserted through the skin into a joint or a fluid-filled sac or saclike cavity. This procedure can be an injection of local anesthetic or pain medication, or the removal of fluid. With injections, the amount and type of medication used must be documented.”

The indictment alleges that Dr. Young told his Medicare patients they needed regular visits to prevent hammer toe. These patients would then return to his practice on a weekly or bi-weekly basis for injections, billed under CPT Code 20605, and incisions, billed under CPT Codes 28270, 28232, 28234, and 28240. For these services he is accused of submitting, or causing to be submitted, claims to Medicare for more than $11.2 million for these medically unnecessary procedures.

In regards to the Unna Boot, it was alleged that Dr. Young regularly submitted false and fraudulent claims to Medicare for "Strapping, Unna Boot," CPT Code 29580, even though his patients routinely received nothing more than minimal Ace bandage wrapped around the ball of the foot that was not medicated. The indictment states that the claims for these services totaled more than $1million.

Historically, podiatric services have been highly scrutinized for healthcare fraud and abuse and is regularly emphasized by Medicare Administrative Contractors (MAC).

For example:

Noridian has provided webinars and information on proper podiatric services.

Previously, a Missouri Podiatrist billed for the more highly reimbursed incision and drainage procedures when he actually only clipped patients' toenails. He was sentenced to a year in prison and paid $1.75 million.

Similarly, a Tennessee Podiatrist plead guilty to healthcare fraud which included billing for nail avulsions (a service covered by Medicare) when he only provided patients routine foot care such as toenail clippings (which is not covered by Medicare).

The list goes on and on.  Simply Google the phrase “podiatrist department of justice” to see how often settlements have occurred regarding foot care. And remember, foot care isn’t exclusively provided by podiatrists.  Primary care physicians as well as orthopedic surgeons often perform foot procedures or provide foot care.  If your practice, hospital, or long term care facility is involved in these kinds of services, consider including them in your annual audit and/or compliance work plan. Otherwise, it could be a real pain in the, uhm, foot.