Elkton physician to pay $1.2 million to satisfy Medicaid billing claims

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Jui Chih Hsu, M.D., an internist in Elkton, has agreed to pay the United States $1,222,222.00 to settle claims that she submitted false claims to the United States for medically unnecessary injections and evaluation and management services that were not documented.

The settlement agreement was announced todayby ActingUnited States Attorney for the District of Maryland Stephen M. Schenning, Nick DiGuilio, Special Agent in Charge of the Office of Inspector General for the Department of Health and Human Services and Maryland Attorney General, Brian Frosh.

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In her practice, Dr. Hsu administered Vitamin B12 and Vitamin B complex injections. Medicare and Medicaid will reimburse Vitamin B12 injections in very limited circumstances, including in patients with pernicious anemia after a documented history of a failed course of Vitamin B tablets. Medicare and Medicaid do not cover Vitamin B12 injections. Additionally in her practice, Dr. Hsu performed routine evaluation and management services for her patients. Medicare and Medicaid do not reimburse for evaluation and management services that are done in conjunction with an injection because a provider is reimbursed for the evaluation needed to do the injection when the provider is reimbursed for the injection itself. Medicare and Medicaid will pay for evaluation and management service that is distinct from an injection procedure. Providers can signify that he or she did a separate and distinct evaluation and management service by using the modifier -25 when submitting the claim for payment.

According to the settlement agreement, Dr. Hsu submitted claims to Medicare and Medicaid for medically unnecessary injections of Vitamin B12 for treatment of chronic fatigue, a condition where reimbursement for Vitamin B12 injections is not permitted. Additionally, Dr. Hsu misrepresented to Medicare and Medicaid that the Vitamin B Complex injections, which are not covered by Medicare and Medicaid, were injections of Thiamine, which is covered by Medicare and Medicaid. Finally, Dr. Hsu inappropriately billed for evaluation and management services using the modifier -25 (significant, separately identifiable evaluation and management by the same physician on the same day of the procedure or other service) which Dr. Hsu failed to document that she in fact performed a separate and distinct evaluation and management service. Dr. Hsu denied the allegations.

This case arose from a recent initiative inside the U.S. Attorney’s Office. The United States Attorney’s Office has dedicated resources to enable it to review Medicare billing data. The review of that data has enabled the United States Attorney’s Office to identify areas of concern where it appears that billing irregularities may have taken place. Partnering with the affected agencies, the United States Attorney’s Office has developed the ability to investigate these billing irregularities to determine whether the matter is appropriate for treatment under the False Claims Act.

ActingU.S. Attorney Stephen M. Schenning commended the HHS Office of Inspector General for its work in the investigation. Mr. Schenning also thanked Assistant United States Attorney Thomas Corcoran, who handled the case.

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