Attorney General Tong Announces $400K Settlement With Waterbury Naturopath and Practice to Resolve Allegations of False Claims and Improper Billing
(Hartford, CT) – Attorney General William Tong and United States Attorney Vanessa Roberts Avery today announced a $399,440 settlement with Waterbury naturopath Marcos DeEscobar and his company Corebella Health, LLC to resolve allegations that they submitted false claims to, and received overpayments from, Medicare and the Connecticut Medicaid programs.
Corebella Health, LLC (“Corebella”) is a practice that provides medical and wellness services to patients in Waterbury. DeEscobar is a naturopath and the owner of Corebella. The allegations against Corebella and DeEscobar arise out of improper billing for allergy immunotherapy preparation, and office visits, also known as evaluation and management (“E&M”) services.
Services performed by a nurse practitioner are typically reimbursed by Medicare and Medicaid at a lower rate than those performed by a physician. There are circumstances where nurse practitioner services are considered “incident-to” physician services, and may be properly billed and reimbursed at the higher physician rate. Among other requirements, incident-to services require a certain level of physician supervision. The state and federal governments allege that Corebella and DeEscobar submitted, or caused to be submitted, false claims to Medicare and Medicaid for services that were supposedly rendered by physicians. In reality, the services were rendered by nurse practitioners, did not meet incident-to supervision requirements, and should not have been reimbursed at the higher physician rate.
When billing for the preparation and provision of allergy immunotherapy, providers must specify the number of units prepared for the patient. The state and federal governments allege that Corebella and DeEscobar received overpayments from Medicare and Medicaid for allergy immunotherapy preparation services by submitting claims for more units than were actually prepared.
Medicare and Medicaid generally consider E&M services that occur on the same day as a procedure to be part of the work of the procedure, and do not allow a separate payment for the office visit. However, when a significant, separately identifiable service is performed by the same physician on the same date of the procedure, the provider can use “Modifier 25” to bill for both the procedure and the E&M services. The state and federal governments allege that Corebella and DeEscobar caused improper claims to be billed to Medicare and Medicaid by adding Modifier 25 to E&M claims when providing allergy injections when, in fact, no significant, separately identifiable E&M services were provided.
To resolve their liability, Corebella and DeEscobar will pay $399,440.55 to the state and federal governments for conduct occurring between January 1, 2016, through December 31, 2018.
"It is alleged that De Escobar and Corebella systematically overbilled Connecticut’s Medicaid program. I thank HHS-OIG and our partners at the United States Attorney’s Office for their coordination and assistance in this matter. Abuse of taxpayer dollars is never acceptable, and we will not hesitate to use the full weight of our authority to protect our public healthcare programs,” said Attorney General Tong.
Anyone with knowledge of suspected fraud or abuse in the public healthcare system is asked to contact the Attorney General’s Government Program Fraud Section at 860-808-5040 or by email at firstname.lastname@example.org; the Medicaid Fraud Control Unit at 860-258-5986 or by email at email@example.com; or the Department of Social Services fraud reporting hotline at 1-800-842-2155, online at www.ct.gov/dss/reportingfraud, or by email to firstname.lastname@example.org.
Assistant Attorney General Joshua L. Jackson, as well as Forensic Fraud Examiners Kevin Jeffko and Lisa Bailey, under the supervision of the Chief of the Government Fraud Section, Gregory K. O’Connell, assisted the Attorney General with this matter. Attorney General Tong also acknowledged the assistance of retired Assistant Attorney General Michael E. Cole.
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