Apple Medical Clinic and its principal, Dr. Michael Johnson, agreed on Apr. 17 to pay a total of $382,362.95 to the United States to resolve allegations that they violated the False Claims Act by causing the submission of false claims to Medicare for electrical muscle stimulation, vitamin injections, and related services that were not medically reasonable or necessary.
The case matters because it addresses concerns about fraudulent billing practices in healthcare and protects federal programs like Medicare from improper charges. The settlement amount is based on Apple Medical Clinic's ability to pay and includes a payment of $175,000 along with the retention of $207,362.95 held by the Centers for Medicare & Medicaid Services.
According to the announcement by Brad D. Schimel, First Assistant U.S. Attorney for the Eastern District of Wisconsin, Apple Medical Clinic offered outpatient pain treatments using an electric stimulation device called Sanexas in combination with vitamin blend injections and other ancillary services such as epidermal nerve fiber density testing. These combined treatments were not covered by Medicare but were advertised as such by Dr. Johnson.
Dr. Johnson was also identified as a major national distributor of the Sanexas device and marketed it for uses outside its Food and Drug Administration clearance and contrary to National Coverage Determinations. The protocols developed maximized profit without regard for medical necessity; National Coverage Determination 160.7.1 excludes coverage for electrical nerve stimulation treatments furnished in physician offices or outpatient clinics.
RST-Sanexas Inc., which developed the device used at Apple Medical Clinic, previously resolved similar False Claims Act allegations in a related agreement involving a payment of $1.5 million to the United States.
The U.S. Attorney for the Eastern District of Wisconsin contributes to community safety across Eastern Wisconsin through public service efforts according to its official website. It is part of the U.S Department of Justice according to its official website and ensures public safety while delivering impartial justice in Eastern Wisconsin according to its official website. The office serves Eastern Wisconsin according to its official website, works alongside law enforcement partners at various levels according to its official website, functions as a federal prosecutorial entity according to its official website, and manages offices in Milwaukee and Green Bay while partnering with law enforcement agencies according to its official website.
