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Dr. Kenneth Martinez and Neurology and Pain Specialty Center Agreed to Pay $919,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Medically Unnecessary or Upcoded Services

On August 18, 2022, Dr. Kenneth P. Martinez and Kenneth P. Martinez, M.D., a Medical Corporation d/b/a Neurology and Pain Specialty Center (collectively, “Dr. Martinez”), Aliso Viejo, California, entered into a $919,644.34 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Martinez submitted claims: (1) using CPT Code 95937 (neuromuscular junction (NMJ) testing) when the NMJ testing was either not medically necessary or was not performed at the applicable standard of care; and (2) using CPT Code 95913 (for thirteen or more nerve conduction studies (NCS)) when Dr. Martinez only performed twelve or fewer NCS. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsel Srishti Sheffner and Deputy Branch Chief Geoffrey Hymans, collaborated to achieve this resolution.

Action Details

  • Date:August 18, 2022
  • Enforcement Types:
    • CMP and Affirmative Exclusions