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OIG Excludes Georgia Laboratory

On July 27, 2015, OIG excluded C.F. Health Management, Inc. d/b/a Gainesville Pain Management (Gainesville), Georgia, for defaulting on payment obligations under a settlement agreement with OIG. The settlement agreement, effective May 17, 2013, required Gainesville to pay $1,577,597 over a period of time. 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. Gainesville's exclusion will remain in effect until it cures the default of its payment obligations and OIG reinstates Gainesville's participation in Federal health care programs. Senior Counsels Geoffrey Hymans and Andrea Treese Berlin represented OIG.

Action Details

  • Date:July 27, 2015
  • Enforcement Types:
    • CMP and Affirmative Exclusions