Delmarva Spine and Pain Agreed to Pay $311,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Upcoded Evaluation and Management Claims and Claims that Misidentified the Place of Services

After it self-disclosed conduct to OIG, KNJ Properties, LLC d/b/a Delmarva Spine and Pain (DSP), Berlin, Maryland, agreed to pay $311,595.86 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that DSP submitted false claims for kyphoplasty services performed by a physician under CPT 22513 and 22514 performed in an office setting when the services were actually performed in an ambulatory surgical center , and false claims for evaluation and management services performed by the physician with modifier 25 when the services were not significant and separately identifiable from other billed services in the same patient encounter and the modifier should not have been submitted.