Improper Coding for Acupuncture Treatment Leads to $1.72 Million Settlement

F.J. Thomas

Nashville, TN (WorkersCompensation.com) – Earlier this year, two Houston Pain Management physicians settled to resolve allegations of violating the False Claims act by improper billing of electrical acupuncture. The Department of Justice alleged that both providers billed for surgical implantation of a neurostimulator electrode when in fact they had only performed acupuncture using an attachable electrical stimulator.

This week, the Middle Tennessee Department Of Justice announced a $1.72 Million settlement to resolve allegations of violating the False Claims Act from improper billing of a surgical implantation code.

The Centers for Medicare and Medicaid Services did not publish a rate for electrical acupuncture (CPT codes 97813, 97814) until 2020. In performing medical audits on procedures involving electrical stimulation, CMS found that providers were often inappropriately billing for implantable neurostimulator HCPC code L8679 when in fact providers were performing electrical acupuncture using a class of nerve stimulators known as “P-STIMs” that are attached and not implanted.

Most P-STIMs devices are attached to the patient’s skin by means of an adhesive with needles that are then attached and inserted to key acupuncture points on the body. Per the manufacturer guidelines, the devices are for one time use only, and are affixed to the patient for up to 4 days until the battery has been spent at which time the device is disposed.

In January 2020, as a result of their audits CMS issued a formal bulletin addressing the inappropriate use of the code L8679. In fact, CMS stated that all L8679 codes billed with an accompanying surgical code would automatically be pended for payment review of medical records.

Earlier this week, the Middle Tennessee Department Of Justice announced a $1.72 Million settlement to resolve allegations of violating the False Claims Act from improper billing of surgical implantation code L8679 from 2016 to 2018. James P. Anderson, M.D of Affiliated Neurologists in Goodlettsville has agreed to pay out $1 million in settlement and has entered an Integrity Agreement for continual monitoring over the next 3 years. Charles F. Spencer, D.C. of Total Family Physicians Center in Murfreesboro has agreed to pay out $700,000 over the next 5 years. Mitchell P. Shea, D.C. of Chiro2Med of Tennessee located in Cookeville has agreed to pay out $20,000 over the next 5 years to resolve the allegations.

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