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Dr. Britton and Gainesville Pain Management Agreed to Pay $1.5 Million for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Excessive Units of Urine Drug Testing and Upcoding the Level of Service Provided

Dr. Matthew James Britton and C.F. Health Management, Inc. d/b/a Gainesville Pain Management (Gainesville), Georgia, agreed to pay $1,577,597 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that Gainesville submitted false or fraudulent claims: 1) by inappropriately using Modifiers 76 and 59, to submit claims for payment for multiple units of Healthcare Common Procedure Coding System (HCPCS) codes G0431 and G0434 when only a single unit may be billed per patient encounter; and 2) by inappropriately using Modifier QW and billing for HCPCS G0431 when the less expensive services represented by HCPCS code G0434 were actually provided.

Action Details

  • Date:May 17, 2013
  • Enforcement Types:
    • CMP and Affirmative Exclusions