The $836,702.88 Dollar False Claims Settlement

Many patients seek help for neck and back pain and when the pain can be isolated to specific structures in the spine, such as the facet joints, injections are often used to treat it.

However, these injections don’t come without some compliance risks. Recently, there have been some settlements for medically unnecessary spine injections and some proactive auditing work performed by the OIG concerning their observed increase in the volume of these services.

For example, a Texas pain clinic and its affiliated ambulatory surgery center agreed to pay the United States and the State of Texas $836,702.88 dollars, no small amount, to resolve allegations they violated the False Claims Act by overbilling federal healthcare programs. In another case, a jury convicted a Houston physician for his role in a scheme involving approximately $1.5 million in fraudulent Medicare claims, including medically unnecessary facet joint injections. According to the U.S. Department of Justice, evidence at trial showed illegal kickbacks were paid to bill Medicare for medically unnecessary facet injections, not provided or both.

Download this free eBrief, “Common Compliance Risks of Spine Injections,” to get the scoop on recent settlements and find out how you can help your organization to avoid medically unnecessary spine injections. This eBrief will cover:

• Recent Settlements and Medical Necessity
• OIG’s Proactive Auditing (And What it Means for Us)
• OIG’s Recommendations for CMS