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Texas Physician and Practice Settle False and Fraudulent Medicare Claims Case

On December 16, 2015, Roberto Diaz, MD (Diaz), entered into a $13,418.56 settlement agreement with OIG. The settlement agreement resolves allegations that Diaz submitted claims for Healthcare Common Procedure Coding System code G0452 (molecular pathology procedure; physician interpretation and report) where: (1) no consultation request had been made; (2) no written narrative report by a consultant physician was produced; and (3) no exercise of medical judgment by a consultant physician was required. In addition, OIG contended that multiple units of this code may have been submitted for each patient encounter where multiple units may not have been medically necessary. Senior Counsels Geoffrey Hymans and Kenneth Kraft represented OIG.

Action Details

  • Date:December 16, 2015
  • Enforcement Types:
    • CMP and Affirmative Exclusions