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New Jersey Medical Biller Settles False and Fraudulent Claims Case and Agrees to 5-Year Exclusion

On September 19, 2016, Susan Toy, entered into a $100,000 settlement agreement with OIG and agreed to be excluded from participating in Federal health care programs for a minimum of five years. On July 1, 2016, OIG issued a letter to Toy, proposing to impose a civil money penalty and program exclusion on her, pursuant to the Civil Monetary Penalties Law. The settlement agreement resolves OIG's allegations that Toy prepared and submitted claims for services that were never performed. Toy, through her health care billing company, prepared and submitted claims for an obstetrics and gynecology physician practice located in New Jersey. Toy was responsible for preparing and submitting claims based, in part, on superbills identifying the services purportedly performed during a patient encounter. OIG contended that Toy prepared and submitted claims for Current Procedural Terminology code 91122 (anorectal manometry) for patient encounters where the procedure was neither performed nor identified as performed on the superbill. Senior Counsels David Blank and Tamara Forys represented OIG with the assistance of Paralegal Specialist Mariel Filtz.

Action Details

  • Date:September 19, 2016
  • Enforcement Types:
    • CMP and Affirmative Exclusions