Legal professional Common Tong Broadcasts $4.2 Million False Claims Settlement with Orange Doctor
(Hartford, CT) – Legal professional Common William Tong at present introduced a $4.2 million joint state and federal settlement with doctor Jasdeep Sidana and his companies DOCS Medical Group, Inc., DOCS Medical Inc., DOCS Pressing Care LLP, Lung Docs of CT, P.C., Epic Household Physicians, LLP and Continuum Medical Group, LLC. Dr. The settlement resolves allegations that Sidana and his companies submitted false claims for fee to Medicare and the Connecticut Medicaid program for medically pointless allergy providers, unsupervised allergy providers, and providers improperly billed as if offered by Sidana. The settlement additionally resolves allegations that Sidana and DOCS improperly billed for sure workplace visits related to COVID-19 exams.
Sidana is a doctor who makes a speciality of pulmonology and is the proprietor and Chief Govt Officer of DOCS, a medical observe with greater than 20 amenities all through Connecticut that gives a wide range of providers to its sufferers, together with main and pressing care, allergy testing and remedy, and COVID testing.
Medicare and Connecticut Medicaid pay just for providers or gadgets which can be medically mandatory. Some providers even have supervision necessities, and allergy exams and the preparation of allergy immunotherapy should be immediately supervised by a doctor. Direct supervision requires the supervising doctor to be current in the identical workplace suite, and instantly accessible to render help if wanted.
In early 2014, DOCS and Sidana began offering allergy testing and remedy providers to their sufferers. The federal government alleges that between October 1, 2016, and September 30, 2017, DOCS and Sidana submitted false claims to Medicare and Medicaid for immunotherapy providers that weren’t medically mandatory, and weren’t immediately supervised by a doctor. The allegations additionally contain claims to Medicare and Medicaid for medically pointless annual re-testing of allergy sufferers between January 1, 2014, and November 11, 2018.
The federal government additionally alleges that between January 1, 2014, and January 1, 2019, DOCS and Sidana submitted claims for medical providers carried out by Sidana on dates of service when he was touring internationally and didn’t carry out or supervise the providers. As an alternative, the providers have been truly carried out by lower-level suppliers, who usually obtain a decrease reimbursement charge from Medicare and Medicaid for such providers.
Lastly, the federal government contends that when administering exams for COVID, DOCS and Sidana improperly billed Medicare and Connecticut Medicaid for sure analysis and administration (“E&M”) providers, generally known as workplace visits. The federal government alleges that between April 1, 2020, and December 31, 2020, on the identical dates that sufferers obtained COVID-19 exams, DOCS and Sidana submitted claims for reasonably advanced “stage 3” E&M providers, when these stage 3 workplace visits weren’t in truth offered.
Along with the $4.2 million fee, Dr. Sidana should enter into an “Integrity Settlement” with a number of compliance necessities and situations, together with annual claims opinions by an unbiased reviewer.
“Dr. Sidana and his extensive community of pressing care facilities engaged in a long-running scheme to overbill the state and federal authorities for medically pointless remedy, in addition to for remedy he and his workforce by no means offered. Along with a $4.2 million penalty, Dr. Sidana and his clinic’s billing might be topic to ongoing oversight and scrutiny to make sure these unacceptable practices by no means happen once more,” mentioned Legal professional Common Tong.
“I be a part of Legal professional Common Tong in condemning this affront to sufferers in Connecticut’s HUSKY Well being/Medicaid program and the taxpayers who fund it. The $4.2 million settlement penalty is the results of intensive investigation and authorized motion by state and federal anti-fraud investigators and attorneys, and we’re grateful for his or her dedication in defending the integrity of our public well being protection providers,” mentioned Division of Social Providers Commissioner Deidre S. Gifford.
The federal and state False Claims Act settlement was reached collectively with the U.S. Legal professional’s Workplace. The investigation was collectively carried out by the U.S. Division of Well being and Human Providers (HHS) Workplace of the Inspector Common/Workplace of Investigations, the U.S. Legal professional’s Workplace and the Workplace of the Connecticut Legal professional Common. The investigation adopted a referral from the Connecticut Division of Social Providers’ Workplace of High quality Assurance. The settlement will reimburse each the federal and state shares of the Medicaid program.
Anybody with information of suspected fraud or abuse within the public healthcare system is requested to contact the Legal professional Common’s Authorities Program Fraud Part at 860-808-5040 or by e mail at firstname.lastname@example.org; the Medicaid Fraud Management Unit at 860-258-5986 or by e mail at email@example.com; or the Division of Social Providers fraud reporting hotline at 1-800-842-2155, on-line at www.ct.gov/dss/reportingfraud, or by e mail to firstname.lastname@example.org.
Forensic Fraud Examiner Thomas J. Martin and Gregory Ok. O’Connell, Chief of the Authorities Program Fraud Part, assisted the Legal professional Common on this matter.