Watertown neurology practice to pay back $850K to government for false claims, including improper billing for Botox

·3 min read

Aug. 3—WATERTOWN — A neurology medical practice on Washington Street has agreed to repay the federal government more than $800,000 for what it admitted was improper and reckless billing, according to the U.S. Attorney's Office.

North Country Neurology PC, a physician-owned medical practice at 1340 Washington St., has agreed to pay back $850,000 for the "improper" and "reckless" billing for medical services, U.S. Attorney Carla B. Freedman announced Wednesday. The doctors listed on the website of the practice include Dr. Abdul Latif, Dr. Sundus Latif, Dr. Mohsin Ali, Dr. Samah Mohiuddin and physician assistant Lisa Trickey.

The neurology practice admitted that on 120 occasions, from 2015 to 2019, it "submitted or caused to be submitted claims for payment to Medicare that improperly listed a physician as the rendering provider for services rendered by a physician assistant when no physician was physically present in the office and immediately available to furnish assistance and direction throughout the performance of the procedure."

In certain circumstances, practices can bill Medicare for services rendered by a non-physician practitioner, such as a physician assistant. North Country Neurology had physicians and a physician assistant employed, but one of the requirements of being able to bill Medicare for services done by a non-physician is that a physician is directly supervising the services, or that the physician is present in the office and immediately available to help with any procedure.

North Country Neurology also improperly billed Medicare for the drug Botox, even though the same Botox had already been paid for by other insurers. From March 2015 through February 2021, the practice purchased Botox for its Medicare patients, while its other patients purchased Botox at a specialty pharmacy and had it shipped to the practice.

The practice admitted that on approximately 761 occasions during this period, its providers administered and the practice billed Medicare for Botox that was paid for by another insurer "in reckless disregard to the fact that Medicare reimbursement for the administration of Botox included reimbursement for the cost of the drug being administered," according to the U.S. Attorney's Office.

North Country Neurology acknowledged that, during the period covered by the settlement agreement, it "had an insufficient compliance program, and one that was not well-suited to identify fraud, waste and abuse."

Shortly after learning of the federal investigation, the practice voluntarily retained a third-party compliance and practice-management consultant to help it develop and implement various practices and procedures to ensure compliance with federal rules and regulations moving forward.

"The integrity of our federal health care system depends on accurate and honest billing by medical providers," said Freedman said. "While North Country Neurology will pay a steep price for submitting false claims for payment to Medicare, I commend the practice and its management for accepting responsibility for its past actions and for implementing forward-looking compliance measures in response to our investigation to assure systems are in place to facilitate and promote ethical and legal conduct in the future."