Mobile, Alabama physician James M. Crumb, a Physical Medicine and Rehabilitative specialist currently practicing as Mobility Metabolism and Wellness, and local neurosurgeon group Coastal Neurological, have collectively paid $1.4 million to settle allegations of False Claims Act violations through fraud schemes meant to "maximize payment" from Medicare, Medicaid, and TRICARE, the Department of Justice announced Thursday.
The United States filed suit in late December 2015, alleging the Defendants knowingly billed federal healthcare programs for "medically unreasonable and unnecessary ultrasound guidance used with routine lab blood draws, and with Botox and trigger point injections."
The United States also said CNI, Crumb, and other CNI physician employees that were not named in the lawsuit manipulated billing codes to bypass safeguards put in place by Medicare's National Correct Coding Initiative to prevent fraudulent duplicate claim billing of certain procedure codes. As part of the scheme, the Defendants sometimes billed 15 to 30 identical ultrasound guidance claims for a single patient visit.
A separate complaint alleged Crumb falsified patient diagnoses to ensure payment from federal healthcare programs, and ordered extra dosages of Botox medications paid by the Alabama Medicaid Agency that were neither medically necessary nor were not used on the patients for whom it was prescribed.
"Because those programs do not cover Botox for pain management, Crumb allegedly used diagnoses of uncommon or rare neurological movement disorders for the sole purpose of obtaining reimbursement for the administered Botox injections," the DOJ said.