New Jersey Pain Clinic Pleads Guilty to Health Care Fraud, to Pay $380K in Fines

TL/DR –

Pain Specialists, a pain clinic with locations in Atlantic, Cape May, and Cumberland Counties, New Jersey, has admitted to overbilling insurance companies for services. The company used a physician’s National Provider Identifier (NPI) to bill Medicare, Medicaid, and private insurance plans for services and procedures while the physician was traveling, which accumulated approximately $58,365.26 in falsely claimed payments. Pain Specialists has agreed to pay criminal restitution of the overcharged amount, a criminal fine of $81,711.36, and a civil settlement of $240,000 to resolve the allegations.

New Jersey Pain Clinic Admits to Health Care Fraud

Pain Specialists, P.A., a New Jersey-based pain clinic with branches in Atlantic, Cape May, and Cumberland Counties, has confessed to overbilling insurance companies, as stated by U.S. Attorney John Giordano. The pain management clinic, located in Northfield, Vineland, and Cape May Courthouse, faced a health care fraud charge before U.S. District Judge Karen M. Williams, to which it pleaded guilty. The clinic also agreed to a civil settlement in light of allegations of violating the False Claims Act.

Fraudulent Billing Practices

Documents from the case reveal that Pain Specialists used the National Provider Identifier (NPI) number of their owner, an anesthesiologist and pain management specialist, to falsely bill Medicare, Medicaid, and private insurance for services and procedures during his absence. The clinic wrongly claimed that services were either personally rendered by him or directly supervised, leading to the fraudulent receipt of approximately $58,365.26.

Violations of Billing Requirements

Additionally, between January 2014 and November 2020, the clinic falsely listed a non-physician practitioner as the provider of services when no physician was present in the office, violating Medicare and Medicaid billing requirements. As such, Pain Specialists has agreed to pay a criminal restitution of $58,365.26, a criminal fine of $81,711.36, and a civil settlement of $240,000. However, the claims resolved by the civil settlement remain allegations, and no liability determination has been made.

Investigation and Prosecution

The case was led by special agents from the U.S. Department of Health and Human Services, FBI Atlantic City Resident Agency, and the U.S. Drug Enforcement Administration. The government was represented by Assistant U.S. Attorneys Daniel A. Friedman and Susan Pappy, and Trial Attorney Daniel Meyler of the Department of Justice’s Civil Division. Riza I. Dagli Esq., a Roseland-based defense counsel, represented Pain Specialists, P.A.

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