A scheme of fraudulent billing has been revealed concerning a chiropractor in Kansas, Timothy Warren and his company Titan. Warren promoted himself to medical providers as a medical reimbursement consultant and said his company was a compliance consulting firm. This case is just one of many in a national investigation of acupuncturists, chiropractors and others for improper billing of a device called P-Stim electro-acupuncture devices. Some have been branded as ANSiStim, Stivax, and NeuroStim electro acupuncture devices. Federal healthcare programs like Medicare do not reimburse for P-Stim devices. The Government is also pursuing cases against P-Stim marketers, distributors and coders to recover millions wrongfully billed over the last couple of years. Beginning in 2014, Warren promoted P-Stim devices as reimbursable by Medicare and other federal healthcare programs and provided instructions on what codes to bill. Those codes, generating a high amount of reimbursement, however, were meant for legitimate, surgically implanted neurostimulators to manage chronic pain. P-Stim, on the other hand, could be applied in a few minutes in an office setting without anesthesia and by someone with minimal training. During this time, Warren and Titan had knowledge that the P-Stim devices were not reimbursable by federal healthcare programs, but continued to promote the non-surgical devices anyway.
In a similar case in Mississipi, a physician and his family medical practice have agreed to pay $375,000 to resolve False Claims Act allegations of P-Stim Device Fraud, announced U.S. Attorney Darren J. LaMarca. Kevin Cooper M.D., and his family medical practice, Cooper Family Medical Center, have agreed to pay $375,000 to resolve allegations that they knowingly and improperly billed Medicare for acupuncture devices in violation of the False Claims Act (“FCA”). The United States alleges that over a one-year period Dr. Cooper, through Cooper Family Medical Center, billed Medicare over $900,000 for non-reimbursable acupuncture devices that were not surgically implanted despite using billing codes indicating that they were. As set forth in the parties’ settlement agreement, the United States alleges that from July 2018 to August 2019, Dr. Cooper routinely presented, or caused to be presented, false claims to Medicare using CPT Code L8680 (implantable neurostimulator, pulse generator) and/or CPT Code 64555 (implantation of peripheral nerve neurostimulator electrodes, accessed through the skin), and received $179,106.72 from Medicare to which he and his clinic were not entitled.
P-Stim is an electro-acupuncture device that, pursuant to manufacturer’s instructions, is affixed behind a patient’s ear using an adhesive. Needles are inserted into the patient’s ear and affixed using another adhesive. Once activated, the device then provides intermittent stimulation by electrical pulses. It is a single-use, battery-powered device designed to be worn for approximately four days until its battery runs out, at which time the device is thrown away. Medicare does not reimburse for such acupuncture devices, nor did Dr. Cooper perform surgical implantation of these devices as he billed to Medicare. Other brand names for this device include Stivax, NeuroStim, ANSiStim, E-Pulse, and NSS-2 Bridge.
In yet another case in Tennessee, three providers were fined for the same kind of wrongddoing. James P. Anderson, M.D. (“Dr. Anderson”), as owner of Affiliated Neurologists, PLC; Charles F. Spencer, D.C., as owner of Total Family Physicians Center PLLC d/b/a Total Family Health & Wellness (“Total Family”); and Mitchell P. Shea, D.C., as owner of Chiro2Med of Tennessee P.C. (“Chiro2Med”), agreed to pay the United States and Tennessee a total of $1.72 million to resolve liability under the False Claims Act for the alleged improper billing for electro-acupuncture using a peri-auricular stimulation device known as “P-Stim” that does not qualify for reimbursement under Medicare or TennCare.From May 2016 through November 2018, Dr. Anderson, Total Family, and Chiro2Med billed for, and were reimbursed by the United States for acupuncture using P-Stim devices under HCPCS Code L8679, which instead requires implantation of a neurostimulator with anesthesia in a surgical setting by a physician, typically a surgeon. Dr. Anderson, Total Family, and Chiro2Med separately billed for, and were reimbursed by, Medicare and/or TennCare for these devices over a two year period.
On June 10, 2020, Tennessee brought suit in the Chancery Court of Davidson County against Dr. Anderson under the Tennessee Medicaid False Claims Act for the false claims he submitted to TennCare. Under the terms of the settlement, Dr. Anderson agreed to pay $1 million to the United States and Tennessee over five years. Dr. Anderson also agreed to enter into an Integrity Agreement with the Office of Inspector General of the U.S. Department of Health and Human Services that will require regular monitoring of its billing practices for a period of three years.Dr. Spencer and Total Family agreed to pay the United States $700,000 over five years.Dr. Shea and Chiro2Med agreed to pay the United States $20,000 over five years.
Jeffrey Newman is a whistleblower lawyer with the firm Jeff Newman Law. He can be reached at firstname.lastname@example.org or at 978-880-4758.