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Digestive Health Specialists Agreed to Pay $91,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Services Not Provided as Claimed

After it self-disclosed conduct to OIG, Digestive Health Specialists, P.A. (DHS), North Carolina, agreed to pay $91,910.01 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that DHS submitted claims to Federal health care programs for items or services that it knew or should have known were not provided as claimed and were false or fraudulent. Specifically, OIG alleged that: (1) DHS submitted claims to Federal health care programs for ultrasound examinations performed at its medical office in Winston-Salem, using Current Procedural Terminology (CPT) Code 76775, when the type of ultrasound procedure performed did not support use of that code; and (2) DHS submitted claims to Federal health care programs for Remicade infusion treatments performed at its medical offices in Winston-Salem and Thomasville, using CPT Code 96415 when the duration of the infusion in certain instances did not support billing under that code.

Action Details

  • Date:July 17, 2018
  • Enforcement Types:
    • Provider Self-Disclosures