John H. Durham, United States Attorney for the District of Connecticut, today announced that HELAR CAMPOS, MD, a physician with a practice in New London and Norwich, has entered into a civil settlement with the government in which he will pay $99,912 to resolve allegations that he violated the False Claims Act.
The allegations against CAMPOS involve fraudulent billing to Medicare and Medicaid for evaluation and management (“E&M") services, commonly referred to as physician office visits. The government alleges that CAMPOS submitted claims to Medicare and Medicaid for E&M services that were not performed in accordance with program requirements. The government alleges that CAMPOS “upcoded" certain office visit services, submitting claims to Medicare and Medicaid by using a higher-paying billing code when services with lower-paying billing codes were actually provided. Specifically, the government alleges that CAMPOS submitted claims for E&M services under CPT code 99214 when he should have submitted the claims under CPT code 99213 or 99212, which are less complex services, reimbursed at a lower rate.
To resolve his liability under the False Claims Act, CAMPOS will pay $99,912 to reimburse the Medicare and Medicaid programs for conduct occurring from Jan. 1, 2009, through Dec. 31, 2012.
Under the False Claims Act, the government can recover up to three times its actual damages, plus penalties of $11,181 to $22,363 for each false claim.
This case was investigated by the Office of Inspector General for the Department of Health and Human Services. The case was prosecuted by Assistant U.S. Attorney Anne F. Thidemann with the assistance of Auditor Kevin A. Saunders.
U.S. Attorney Durham encouraged individuals who suspect health care fraud to report it by calling the Health Care Fraud Task Force (203) 785-9270 or 1-800-HHS-TIPS.
Source: U.S. Department of Justice, Office of the United States Attorneys
