Sureshkumar Muttath, Medicare Fraud, Maryland 2023

Baltimore, Maryland – A Riverdale doctor has agreed to pay $1,526,038 to settle allegations that he submitted false claims to the United States for medically unnecessary autonomic nervous function tests and neurobehavioral status exams.

Sureshkumar Muttath, M.D., an internist in Riverdale, Maryland, has agreed to pay the United States $1,526,038 to settle allegations that he submitted false claims to the United States for medically unnecessary autonomic nervous function tests and neurobehavioral status exams.

The settlement agreement was announced by United States Attorney for the District of Maryland Robert K. Hur, Special Agent in Charge of the Office of Inspector General for the Department of Health and Human Services, Maureen Dixon, and Maryland Attorney General, Brian Frosh.

According to the settlement agreement, from January 1, 2011 to June 30, 2017, Dr. Muttath submitted claims to Medicare and Medicaid for medically unnecessary autonomic nervous function tests (CPT codes 95921-95924). The United States contends that these tests were not medically necessary and otherwise were excluded from coverage under both programs because Dr. Muttath did not have the necessary equipment to perform these tests; the patients who underwent the testing had not been diagnosed clinically with an autonomic function disorder before Dr. Muttath conducted the tests; Dr. Muttath did not have the specific training required to conduct autonomic function tests or interpret the results thereof; Dr. Muttath failed to follow Novitas's Local Coverage Determinations (L34788 and L35395) regarding coverage indications, limitations, and medical necessity for autonomic function testing; and Dr. Muttath performed autonomic function tests merely to monitor patient symptoms or conduct patient screenings without signs or symptoms of autonomic dysfunction and not to make any clinical decisions or manage patient care.

With regard to the neurobehavioral status exam claims billed by Dr. Muttath using CPT code 96116, the United States alleges that Dr. Muttath misrepresented the services he actually performed (mini-mental status exams) as neurobehavioral status exams because he failed to spend the required amount of time either face-to-face with the patient or interpreting the tests and preparing the reports and because he did not conduct the required assessments of the patients' thinking, reasoning, and judgment to submit claims under CPT code 96116.

Dr. Muttath denied the United States' allegations.

Also as part of the settlement, Sureshkumar Muttath, M.D. has agreed to enter into an expansive, three-year Integrity Agreement that provides for procedures and reviews to be put in place to avoid and promptly detect conduct similar to that which gave rise to the settlement.

Source: https://www.justice.gov/usao-md/pr/united-states-reaches-settlement-riverdale-internist-resolve-false-claims-act-allegations