10/30/2015- I wanted to post all the comments from the PenBay Pilot and Bangor Daily New Article. Horrible. I think Lynda/PenBay Pilot is on the board of directors for "Our Town Belfast". I get deleted when I offend downtown Belfast.
http://www.penbaypilot.com/article/us-government-files-629816-complaint-against-lincolnville-dermatology-business/61222
Settlement reached
U.S. government files $629,816 complaint against Lincolnville dermatology business
Posted:
Tuesday, October 27, 2015 - 9:45pm
Attachments
Because the federal False Claims Act allows at least double damages, the U.S. attorney is asking for $629,816 in compensation. The complaint, filed in U.S. First District Court in Portland, outlines a settlement with the dermatologists.
“Based on the United States’ investigation, Defendant Maine Dermatology acted with knowledge or reckless disregard of clear guidance from the Medicare Program that its Medicare claims at issue were ineligible for payment,” wrote U.S. Assistant Attorney John G. Osborn.
Maine Dermatology LLC operates a skin care center at 2239 Atlantic Highway (Route 1), Lincolnville.
Through its attorney, Lawrence Vernaglia, of the Boston-based Foley & Lardner, Maine Dermatology LLC issued the following statement Oct. 28:
“Maine Dermatology, LLC Announces Settlement
“Maine Dermatology, LLC has reached an agreement with the
United States to resolve an investigation related to certain technical
documentation requirements for the Medicare program. The practice does
not admit any improper conduct as part of the settlement and there were
no patient care issues alleged.
“Maine Dermatology’s providers help patients achieve healthy skin through early surveillance. They strive to provide thorough skin examination and develop individualized treatments to meet each patient's unique needs. Their top priority is providing patients with the highest standard of skin care in a professional and compassionate manner.
“Maine Dermatology’s providers help patients achieve healthy skin through early surveillance. They strive to provide thorough skin examination and develop individualized treatments to meet each patient's unique needs. Their top priority is providing patients with the highest standard of skin care in a professional and compassionate manner.
The settlement agreement will permit us to remain focused
on providing our patients with the highest quality of care. It has
always been the intention of Maine Dermatology to comply with all
requirements of the Medicare program. We appreciate the opportunity to
work with the United States to resolve this matter. We thank all of our patients for their support throughout this process.”
“Under Medicare, any services billed must be medically necessary, and any provider billing Medicare must have documentation showing the medical necessity of those services,” he wrote. “Under Medicare, a participating provider can bill the program for evaluation and management services (“E&M services,” also known as office visits) provided to a patient on the same day as a separate procedure or procedures only if the provider can show that the E&M service for which it seeks payment is a significant, separately identifiable service from the other procedures provided.
“Providers must use Modifier 25 in order to receive reimbursement for providing E&M services to a patient on the same day as a separate procedure. When using Modifier 25, Medicare requires the provider to produce documentation, on request, demonstrating that the E&M service was a significant, separately identifiable service from the other services provided.
“Medicare regulations also require that providers accurately bill for the services that they provide. On claims submitted to Medicare, providers use Current Procedural Terminology (“CPT”) codes to describe the services that were provided to a beneficiary. The CPT codes for established patient office visits range from 99211 to 99215. The complexity of the office visit and/or the length of time spent with the patient determines the correct CPT code to use, with 99211 representing the shortest/simplest office visit and 99215 representing the lengthiest/most complex office visit.
“Medicare reimbursement increases as the length and complexity of the visit increases.”
For three years, DHHS maintains that the Lincolnville dermatologists, “in a significant number of instances... billed Medicare for providing E&M services to individual patients on the same day that it had also billed for medical procedures, despite the fact that each E&M service was not a significant, separately identifiable service from the procedures provided.”
An investigation by the Office of Inspector General maintains that the dermatologists billed Medicare for lengthier and/or more complex services than it had actually provided.
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? my comment got deleted. Dr. Mark Jensen (psych) and Dr. Charmain Jensen (plastic surgeon) are not dermatologists either. She was treating my child since August. She knew who I was because I stand up up against fraud in Belfast. She told me she lived by me. They have young children too. I had asked her about laser for acne- she said her husband does that and she'd check with him. A psychiatrist masking as a dermatologist using laser on my child. Thank goodness this story broke before that.
Laurie Allen
http://bangordailynews.com/2015/10/27/news/midcoast/midcoast-dermatology-practice-to-pay-630000-in-settlement/comments/
Midcoast dermatology practice to pay $630,000 in settlement
Posted Oct. 27, 2015, at 12:57 p.m.BANGOR, Maine — Maine Dermatology of Lincolnville has agreed to pay nearly $630,000 to settle claims involving false billing to Medicare between June 2010 and August 2013, according to the U.S. attorney’s office.Comments for this thread are now closed.
Medicare provides health insurance primarily to disabled and elderly Americans.
Court documents filed Monday in U.S. District Court in Bangor said the practice billed Medicare for providing evaluation and management services to patients in violation of applicable Medicare billing guidelines, a news release from the U.S. attorney’s office said. The complaint alleged Maine Dermatology submitted $314,908 in false claims to Medicare. The complaint sought damages double the full amount of the false claims filed by Maine Dermatology, which cooperated in the investigation.
The investigation was conducted by the U.S. Department of Health and Human Services, Office of Inspector General and the U.S. Attorney’s Office, led by Health Care Fraud Investigator Richard Fairfield.
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