JACKSONVILLE, Fla. – Bao Pham, D.O., and AccMed Healthcare Systems, LLC, doing business as Florida Spine Care and Pain Center, have paid $448,794 to resolve allegations that they violated the False Claims Act by submitting false claims for medical services to the Medicare and federal Office of Workers Compensation programs, the U.S. Attorney's Office announced Monday.
Pham is an osteopathic physician who focuses his practice on pain management and who, through Florida Spine Care and Pain Center, provides treatment to Medicare recipients for various conditions and to federal employees who are suffering various types of on-the-job injuries. Florida Spine Care and Pain Center is a Florida corporation located in Clay and Duval counties.
Medicare benefits are available to eligible patients who are disabled or are aged 65 and older and who are enrolled in Part B of the Medicare Program to obtain benefits from participating healthcare providers. The federal OWCP benefits are available to federal civilian workers who are injured at work or who have acquired an occupational disease.
The settlement resolves allegations that between Jan. 1, 2004, and Dec. 31, 2008, Pham and Florida Spine Care and Pain Center submitted false Medicare and OWCP claims for non-reimbursable procedures and services by upcoding and unbundling medical services provided to beneficiaries of these two federal programs. The government alleged that Pham and Florida Spine Care and Pain Center upcoded a non-reimbursable procedure, performed in-office, as a surgical procedure and further routinely unbundled claims for certain pain management services in order to obtain reimbursement that would be higher than if properly submitted.
"This settlement represents another notable achievement in our battle against health care fraud in this district," said A. Lee Bentley, III, Acting United States Attorney for the Middle District of Florida. "Civil health care fraud enforcement is, and will continue to be, one of our top priorities."
These allegations arose as a result of information received from a fraud investigator at a major health insurance carrier, which was simultaneously conducting an investigation into Dr. Pham's billing practices.
This matter was handled by the U.S. Attorney's Office for the Middle District of Florida, the Office of the Inspector General for the Department of Health and Human Services, the Office of the Inspector General for the Department of Labor and the Office of Inspector General for the United States Postal Service.
The matter was settled prior to filing suit by the United States of America. The claims settled by this agreement are allegations only; there has been no determination of liability.