Defendants Toccoa Clinic Medical Associates, LLC and two individual dermatologists–Dr. Margaret Kopchick and Dr. Russell Burken–have agreed to pay $1.9 million to settle allegations that they violated the False Claims Act by overbilling Medicare for dermatological procedures.
This settlement resolves a qui tam action filed by our client Rachel Jimenez in the Northern District of Georgia. Toccoa Clinic settled allegations raised by Ms. Jimenez and the United States that it billed for office (E&M) visits on the same day as procedures and upcoded certain therapies and office visits to higher paying codes. Providers are not permitted to bill both evaluation services and a procedure on the same day under the Medicare program’s regulations unless a significant, separately identifiable service has been performed.
The Department of Health and Human Services has identified inappropriate billing of E&M services as a national issue costing taxpayers billions of dollars. “Physicians and practice groups are expected to bill Medicare for the costs of the services they provide,” said U.S. Attorney John Horn in announcing the settlement. “When they bill improperly for those services, it affects those who depend on Medicare by taking available dollars away from the program.”
Relator Rachel Jimenez, a former medical aesthetician and laser practitioner at Toccoa Clinic, filed a qui tam action in August 2012. During the four years her case was being prepared and investigated, she worked with her attorneys and the government to provide whatever assistance she could. At one point, Ms. Jimenez even received a call from the defendants’ attorney, who was unaware that she was the relator of a sealed FCA case. Ms. Jimenez, will receive a $285,000 relator’s share, which she intends to use to pay off the mortgage on her house.
Bracker & Marcus LLC thank Ms. Jimenez for her integrity and courage. It has been an honor and a pleasure to represent her in this matter, and we could not be more thrilled for her. We also would like to thank Assistant United States Attorneys Emily Shingler and Christopher Huber and investigator Kit Duncan for their tireless efforts, and congratulate them on a successful settlement.