CAMDEN – Pain Specialists P.A., which operates pain clinics in Cape May Court House as well as in Atlantic and Cumberland counties, has admitted in federal court to overbilling insurance companies for services provided.
U.S. Attorney John Giordano announced on Thursday, March 20, that a settlement had been reached with Pain Specialists, which has offices in Northfield and Vineland besides the Cape May Court House location.
The business, whose principals were not identified by the U.S. attorney, pleaded guilty before U.S. District Judge Karen M. Williams to health-care fraud. Pain Specialists also signed a civil settlement with the United States to resolve allegations that it violated the False Claims Act.
According to Giordano, Pain Specialists was owned by a physician specializing in anesthesia and pain management, identified in court documents as Individual-1.
Between November 2015 and January 2020, when Individual-1 was traveling and not physically present at a Pain Specialists location, Pain Specialists used Individual-1’s National Provider Identifier number to bill Medicare, Medicaid and private insurance plans for services and procedures requiring Individual-1’s in-person consultation or Individual-1’s direct supervision of the rendering provider.
Pain Specialists received approximately $58,365 for services purportedly rendered by Individual-1 or purportedly directly supervised by him while he was traveling and out of the office.
In addition, Pain Specialists entered a civil settlement with the United States to resolve allegations that, between January 2014 and November 2020, the business improperly listed a physician as the rendering provider for services that were provided by a non-physician practitioner when no physician was present in the office.
This was in violation of Medicare requirements and in violation of Medicaid’s requirement that providers bill under their own NPI number.
Pain Specialists agreed to pay criminal restitution of $58,365, a criminal fine of $81,711 and a civil settlement of $240,000. The claims resolved by the civil settlement are allegations only, and there has been no determination of liability.
Giordano credited multiple government and law enforcement agencies with contributing to the case’s investigation and resolution.
