Acting United States Attorney Lisa G. Johnston has announced that Med-Surg Physician Group Inc., along with its owner Oluyemisi Sangodeyi, M.D., will pay $152,382.70 to settle allegations of violating the federal False Claims Act. The claims concerned the submission of false payment requests to Medicare and Medicaid, as well as falsely certifying program compliance.
Med-Surg, based in Beckley, West Virginia, provides general internal medicine and medication-assisted treatment for substance use disorder. An analysis revealed unusual billing patterns involving the Healthcare Common Procedure Coding System (HCPCS) procedure code Q3014, designed for telehealth services. The code permits only the originating site to charge a facility fee, but Med-Surg improperly billed for telehealth sessions conducted from patients' homes, according to the investigation.
West Virginia's Medicaid program policy clearly states that providers cannot bill for the originating site when it is the patient's home. Despite this, Med-Surg submitted claims with the Q3014 code from March 25, 2020, to January 27, 2021, leading to $76,191.35 being improperly received from Medicare and Medicaid.
"Dr. Sangodeyi and Med-Surg repeatedly billed for fees they knew they were not entitled to, at the expense of the American taxpayer," stated Acting United States Attorney Lisa G. Johnston. She commended the investigative work of the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG) and West Virginia Attorney General’s Medicaid Fraud Control Unit, and praised staff involved in reaching this settlement.
Maureen R. Dixon of HHS-OIG highlighted the necessity of accurate reimbursement claims, affirming ongoing efforts to investigate fraud in federal health programs. West Virginia Attorney General JB McCuskey reiterated the commitment to protecting Medicare and Medicaid funds' intended purposes.
The U.S. Attorney’s Health Care Fraud Task Force coordinates efforts from multiple law enforcement agencies to address fraud affecting public health care programs.
A full copy of the press release is available on the U.S. Attorney’s Office for the Southern District of West Virginia's website.
