Vanessa Roberts Avery, United States Attorney for the District of Connecticut, and Phillip Coyne, Acting Special Agent for the United States Department of Health, Office of the Inspector General, announced today that JASDEEP SIDANA, MD, and DOCS MEDICAL GROUP, INC (doing business as Docs Medical), DOCS MEDICAL INC., DOCS URGENT CARE LLP, LUNG DOCS OF CT, PC, EPIC FAMILY PHYSICIANS, LLP and CONTINUUM MEDICAL GROUP, LLC (collectively, “DOCS”) have entered into a civil settlement agreement with the federal and state governments, in which they will pay a total of $4,267,950.21 to resolve allegations that they made false payment claims to Medicare and the Connecticut Medicaid program for medically unnecessary allergy services, unattended allergy services, and services that were improperly billed though provided by Sidana. The agreement also eliminates allegations that Sidana and DOCS failed to properly bill for certain office visits related to COVID-19 testing.
Sidana is a physician specializing in pulmonology and the owner and chief executive officer of DOCS, a medical practice with more than 20 facilities throughout Connecticut that offers patients a variety of services including primary and emergency care, allergy testing and treatment. and COVID testing.
Medicare and Connecticut Medicaid only pay for services or items that are medically necessary. Some services also have oversight requirements, and allergy testing and allergy immunotherapy preparation must be directly overseen by a doctor. Direct monitoring requires the attending physician to be present in the same office space and immediately available to provide assistance if necessary.
In early 2014, DOCS and Sidana began providing allergy testing and treatment services to their patients. The government alleges that between October 1, 2016 and September 30, 2017, DOCS and Sidana misrepresented Medicare and Medicaid about immunotherapy services that were not medically necessary and were not directly supervised by a physician. The allegations also include claims against Medicare and Medicaid for medically unnecessary annual repeat testing of allergy patients between January 1, 2014 and November 11, 2018.
The government also alleges that between January 1, 2014 and January 1, 2019, DOCS and Sidana filed claims for medical services provided by Sidana on duty days when he was traveling internationally and had not provided or supervised the services. Instead, the services were actually provided by subordinate providers, who typically receive a lower reimbursement rate from Medicare and Medicaid for such services.
Finally, the government alleges that DOCS and Sidana improperly billed for certain assessment and management (“E&M”) services, commonly referred to as office visits, in conducting testing for COVID Medicare and Connecticut Medicaid. The government alleges that DOCS and Sidana submitted requests for moderately complex “Level 3” E&M services between April 1, 2020 and December 31, 2020, the same dates patients received COVID-19 tests, when these level 3 office visits were not actually planned.
“It is a disgrace that Medicare and Medicaid programs withhold federal funds that have been allocated for the care and treatment of beneficiaries,” said US Attorney Avery. “Medical services billed by Medicare and Medicaid must be provided based on the individual medical needs of each patient. Providers participating in government programs may only bill for medically necessary services and must provide accurate accounting for services rendered. This office seeks to vigorously prosecute health care providers who make false or fraudulent claims about federal health programs.”
“Healthcare providers are expected to follow Medicare rules closely and bill properly — no more, no less,” said Special Agent Phillip M. Coyne of the US Department of Health and Human Services, Office of the Inspector General. “When that obligation is breached, government health programs — and American taxpayers — pay the price. We are committed to pursuing these types of allegations with our law enforcement partners as we work to protect the integrity of our federal healthcare system.”
As part of this agreement, DOCS and Sidana entered into a three-year Integrity Agreement with the Department of Health and Human Services, Office of the Inspector General, designed to ensure future compliance with federal health program requirements.
This matter was investigated by the Office of the Inspector General of the Department of Health and Human Services and the Connecticut Attorney General’s Office. This case was prosecuted by Assistant US Attorney Sara Kaczmarek with the assistance of Comptroller Kevin Saunders and Assistant Assistant Attorney General Gregory O’Connell.
Individuals who suspect healthcare fraud are encouraged to report it by calling 1-800-HHS-TIPS or the Health Care Task Force at (203) 777-6311.