MARCOS DeESCOBAR, False Claims, Connecticut 2016

A Connecticut naturopath and his practice have agreed to pay $399,440.55 to resolve allegations that they submitted false claims to, and received overpayments from, the Medicare and Medicaid programs.

Vanessa Roberts Avery, United States Attorney for the District of Connecticut, Phillip Coyne, Special Agent in Charge for the U.S. Department of Health and Human Services, Office of the Inspector General, and William Tong, Connecticut Attorney General, announced the settlement on behalf of COREBELLA HEALTH, LLC, and its owner, MARCOS DeESCOBAR.

Services performed by a nurse practitioner are typically reimbursed by Medicare and Medicaid at a lower rate than those performed by a physician. There are circumstances where nurse practitioner services are considered ‘incident-to’ physician services, and may be properly billed and reimbursed at the higher physician rate. The government alleges that Corebella and DeEscobar submitted, or caused to be submitted, false claims to Medicare and Medicaid for services that were supposedly rendered by physicians. In reality, the services were rendered by nurse practitioners, did not meet incident-to supervision requirements, and should not have been reimbursed at the higher physician rate.

When billing for the preparation and provision of allergy immunotherapy, providers must specify the number of units prepared for the patient. The government alleges that Corebella and DeEscobar received overpayments from Medicare and Medicaid for allergy immunotherapy preparation services by submitting claims for more units than were actually prepared.

Medicare and Medicaid generally consider E&M services that occur on the same day as a procedure to be part of the work of the procedure, and do not allow a separate payment for the office visit. However, when a significant, separately identifiable service is performed by the same physician on the same date of the procedure, the provider can use ‘Modifier 25’ to bill for both the procedure and the E&M services. The government alleges that Corebella and DeEscobar caused improper claims to be billed to Medicare and Medicaid by adding Modifier 25 to E&M claims when providing allergy injections when, in fact, no significant, separately identifiable E&M services were provided.

To resolve their liability, Corebella and DeEscobar paid $399,440.55 to the federal and state governments for conduct occurring between January 1, 2016, through December 31, 2018.

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