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Florida Physicians and Practice Settle False and Fraudulent Claims Case

Jaime L. Sepulveda, MD, LLC (d/b/a Miami Urogynecology Center), Jaime L. Sepulveda, M.D., and Sujata Yavagal, M.D. (collectively, "Miami Urogynecology Center"), South Miami, Florida, entered into a $173,768.08 settlement agreement with OIG. The settlement agreement resolves allegations that Miami Urogynecology Center submitted claims to Medicare for items or services that it knew or should have known were not provided as claimed and were false or fraudulent. Specifically, OIG contended that Miami Urogynecology Center submitted claims for: (1) diagnostic electromyography services using CPT code 51784 when therapeutic, not diagnostic, services had been provided; (2) pelvic floor physical therapy services using CPT codes 97032 and 97110 when those services were provided by an unqualified individual; and (3) evaluation and management (E&M) services using CPT codes 99213 and 99214 that were billed in conjunction with pelvic floor therapy procedures when no separate and identifiable E&M services were provided. OIG's Consolidated Data Analysis Center and Office of Counsel to the Inspector General, represented by Senior Counsels Srishti Sheffner and Michael Torrisi, with the assistance of Program Analyst Mariel Filtz, collaborated to achieve this settlement.

Action Details

  • Date:October 24, 2018
  • Enforcement Types:
    • CMP and Affirmative Exclusions