A New Jersey doctor will forfeit $69,880 in kickbacks he received in 2010 and 2011 after pleading guilty to one count of violating the federal anti-kickback statute.
Dr. William Lagrada allegedly accepted $5,820 in cash from a cooperating government witness in October 2011 for referrals he made to Orange (N.J.) Community MRI in September, according to the U.S. Attorney’s Office in New Jersey. He accepted another cash payment of $5,420 in November for October’s referrals to the diagnostic facility, the U.S. attorney stated.
As part of the scheme, Orange Community MRI made monthly cash payments in exchange for patient referrals for magnetic resonance imaging (MRIs), ultrasounds, echocardiograms, computed axial tomographies (CT scans) and dual-emission X-ray absorptiometries, the U.S. Attorney stated.
Twelve other New Jersey doctors and a nurse practitioner also were charged with taking envelopes of cash from Orange Community MRI in exchange for patient referrals, the U.S. Attorney stated. And an Orange Community MRI executive was charged in a separate complaint in connection with the scheme.
In an unrelated case, two Detroit-area residents were charged with allegedly submitting fraudulent claims to Medicare for more than $8.8 million through their company, Miracle Home Health, according to the FBI’s Detroit division. The claims were for home health services that were medically unnecessary or not provided.
Court documents allege that Usha Shah and Deepak Shah conspired to pay cash kickbacks for Medicare beneficiaries’ information then would use that identification to bill Medicare, the FBI stated.
Nerve Conduction Study issue posted for RAC Region B
In recovery auditor (RAC) news, CGI, the RAC for Region B, posted an issue about nerve conduction study using CPT code 95904 (Nerve conduction, amplitude and latency/velocity study, each nurse; sensory) when more than three units are billed.
RACs in Region A, C and D did not post issues in the past week.
Name of issue
Date posted or approved
Regions/states where it is active
Description of issue
Nerve conduction study CPT code 95904, greater than three units billed
RAC Region B
Semi-automated review. According to CPT, the frequency for a nerve conduction study with the diagnosis of mononeuropathy is three units per date of service. Therefore, testing beyond that amount is considered unusual for that condition.
NGS LCD L26869; NEUROMetrix nerve conduction studies (NCS) and needle electromyography (EMG) procedures, reimbursement and coding information (2011)
About the Author
Karen Long is the compliance product manager for DecisionHealth and oversees products that relate to fraud and abuse and HIPAA compliance for physician offices and home health agencies, and accreditation compliance for hospitals. In her almost four years at DecisionHealth, Karen also has been the compliance editor and a reporter for Home Health Line, nation's leading independent authority on home healthcare business, regulation and reimbursement.
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