$1M Settlement Reached In False Claims Case Against Oral Pain Center
A Wisconsin pain treatment clinic has reached a settlement in which it will pay $1 million as a resolution to claims that it had been submitting false claims to both Tricare and Medicare – an Oral Pain Center for devices designed to address temporomandibular joint disorder, otherwise known as TMJ.
With four distinct clinics in and around Milwaukee, TMJ & Orofacial Pain Treatment Centers agreed to settle the case without an admission of liability, as was reported in a press release from the Eastern District of Wisconsin U.S. Attorney’s Office dated January 15.
U.S. Attorney Matthew Kruger explained in the statement that the settlement would hopefully send a strong signal to healthcare providers that there will be no tolerance whatsoever for this kind of false billing.
The Centers in Question Focus on the Treatment of TMJ Disorder
These centers often incorporate the prescription of oral devices to help keep the jaws of patients in a stable position and the clinics were said to have purchased such appliances from third-party providers charged with fabricating them.
It is alleged that the Oral Pain Center then submitted fraudulent bills to Medicare as well as Tricare, the U.S. military health insurance carrier, using codes that actually refer to very costly appliances fabricated not by third-party labs, but by surgeons. This allowed the clinics to receive higher rates.
Kruger added that healthcare providers will not be permitted to misrepresent the materials and services given to patients just so that they may boost billings and defraud the government.
A probe into the clinics’ activities was first triggered by a False Claims Act lawsuit filed by a whistleblower, who will also receive a portion of the settlement money. The complaint will now be dismissed at the request of the whistleblower, pursuant to the terms of the settlement agreement.
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