Western New York Medical P.C. has agreed to a settlement of $251,477 to address allegations related to improper billing practices for chronic care management services under Medicare. Acting U.S. Attorney Joel L. Violanti announced the resolution, highlighting that the claims in question were associated with false submissions to federal health care programs.
Assistant U.S. Attorney David M. Coriell, who managed the case, explained that WNY Medical operates in Erie and Niagara Counties. The government alleges that between January 1, 2020, and March 31, 2023, WNY Medical submitted claims for chronic care management encounters without providing the requisite minimum of 20 minutes of clinical staff time per month as required by current procedural terminology guidelines.
Acting U.S. Attorney Violanti emphasized the importance of accurate reporting by providers: “The financial integrity of the Medicare program depends on providers accurately and truthfully reporting the services that they are providing,” he said. He added that his office is dedicated to safeguarding Medicare's integrity by ensuring accountability among providers seeking unwarranted payments.
The settlement was achieved through collaboration between the U.S. Attorney’s Office for the Western District of New York and the U.S. Department of Health and Human Services Office of Inspector General.
It is important to note that while these claims have been resolved through settlement, there has been no determination of liability regarding these allegations.
