PHILADELPHIA – In a shocking case of Medicare scamming, two chiropractors and their clinics have agreed to pay a total of $1,952,000 for bilking the government out of millions of dollars using electric stimulation devices.
U.S. Attorney Jacqueline C. Romero announced the settlements, which are the latest actions in the national investigation into the improper billing involving the RST Sanexas neoGEN-Series device (“Sanexas”). The device is marketed to treat various forms of pain and other medical conditions, but patients were receiving two treatments per week for 12 weeks, totaling 24 treatments, which lasted approximately 30-40 minutes. In conjunction with Sanexas treatment, the clinics injected patients with a vitamin blend.
The settlements are pursuant to DOJ’s inability to pay policy. Joseph M. Childs, 56, of Downingtown, Pennsylvania, and Charles H. Durr, 59, of Hershey, Pennsylvania, co-owners of Active Integrated Medical Centers, PC (collectively, “Active Integrated”), agreed to pay $1,900,000 to resolve liability under the False Claims Act for the alleged improper billing of “Sanexas” and “TM Flow” devices, as well as epidermal nerve fiber density (“ENFD”) testing.
Childs and Durr’s clinic submitted over 67,000 claims for payment to Medicare involving application of the Sanexas device, often billed with accompanying vitamin injections under various procedure codes and injection codes. The United States contends that Medicare did not permit reimbursement of Sanexas or vitamin injections used in conjunction with Sanexas in the way in which Active Integrated administered them.
Separately, Taylor Vanden Wynboom, 44, of Ankeny, Iowa, a chiropractor and owner of Nova Integrated Health, PC (collectively, “Nova”), agreed to pay $52,000 to resolve liability under the False Claims Act for the alleged improper billing of the Sanexas device and ENFD testing. Nova submitted approximately 33,000 claims for payment to Medicare involving application of the Sanexas device.
The United States Attorney’s Offices for the Eastern District of Pennsylvania and Southern District of Iowa worked closely to file a complaint and ultimately finalize a settlement in the matter of Wynboom, who had declared Chapter 7 bankruptcy. The settlements are a result of the Department of Justice’s ongoing efforts to combat healthcare fraud and recover millions of dollars from individuals and organizations that bilk the Medicare system.
The investigation revealed that National Coverage Determination 160.7.1 states: “Electrical nerve stimulation treatments furnished by a physician in his/her office, by a physical therapist or outpatient clinic are excluded from coverage by § 1862(a)(1) of the Act.” Local Coverage Determination (“LCD”) 35222 reinforces that “[t]he use of electrostimulation alone for the treatment of multiple neuropathies or peripheral neuropathies caused by underlying systemic diseases is not medically reasonable and necessary.”
The United States Food and Drug Administration cleared Sanexas as substantially equivalent to a predicate device. However, the investigation revealed that the device was not used in accordance with the approved indications.
The United States contends that the clinics’ actions were a result of a deliberate scheme to defraud Medicare. The settlements are a significant step in holding these individuals and organizations accountable for their actions and recovering millions of dollars that were bilked from the Medicare system.
The case is part of the Department of Justice’s ongoing efforts to combat healthcare fraud and recover millions of dollars from individuals and organizations that bilk the Medicare system.
Related Federal Cases
- Western Union Scam · Washington
- FDIC Appoints Five New Members to Advisory Committee on Community Banking · Mississippi
- Republic First Bank Collapses: Fulton Bank Swoops In · Iowa
- Attorney General James Co-Leads Coalition to Save Humanitarian Parole Program · Pennsylvania
- Live Nation Faces Trial Over Monopoly Practices · Washington
Key Facts
- State: Pennsylvania
- Agency: DOJ USAO
- Category: Fraud & Financial Crimes
- Source: Official Source ↗
🔒 Get the grimiest stories delivered weekly. Subscribe free →
Browse More
