A pain clinic in New Jersey has admitted to overbilling insurance companies for services, according to U.S. Attorney John Giordano. Pain Specialists, P.A., with locations in Northfield, Vineland, and Cape May Courthouse, pleaded guilty to health care fraud before U.S. District Judge Karen M. Williams.
The clinic was charged with using the National Provider Identifier (NPI) number of its owner, a physician specializing in anesthesia and pain management referred to as "Individual-1," to bill Medicare, Medicaid, and private insurance plans for services requiring Individual-1's presence when he was not available. This occurred between November 2015 and January 2020 while Individual-1 was traveling.
Pain Specialists also resolved allegations of violating the False Claims Act by entering a civil settlement with the United States. The settlement addressed claims that from January 2014 to November 2020, the clinic improperly listed a physician as the rendering provider for services performed by non-physician practitioners without a physician present.
As part of their agreement, Pain Specialists will pay $58,365.26 in criminal restitution and an $81,711.36 criminal fine. Additionally, they agreed to a civil settlement amounting to $240,000. It is noted that these are allegations only with no determination of liability.
U.S. Attorney Giordano acknowledged the contributions of several agencies: special agents from the U.S. Department of Health and Human Services' Office of Inspector General; FBI Atlantic City Resident Agency; Healthcare Fraud Task Force; and the U.S. Drug Enforcement Administration's New Jersey Division.
The government is represented by Assistant U.S. Attorneys Daniel A. Friedman and Susan Pappy along with Trial Attorney Daniel Meyler from the Department of Justice’s Civil Division.
Defense counsel for Pain Specialists is Riza I. Dagli Esq., based in Roseland, New Jersey.
