by Ben Vernia | November 16th, 2014
On November 4, the FBI announced that a Cicero, New York chiropractor had agreed to pay over $375,000 and enter into a three-year integrity agreement with the Office of Inspector General of HHS, to resolve allegations that he submitted claims for medically unnecessary procedures and “upcoded” others (charged a higher-reimbursement procedure code than the one appropriate for the services rendered). According to the FBI’s press release:
ALBANY, NY—Joseph Borio—the owner of Borio Chiropractic Health Center (BCHC), in Cicero, New York—has agreed to pay the United States $376,436.76 to resolve allegations that he violated the False Claims Act by submitting claims to Medicare using higher billing codes than appropriate and falsely certifying that the services billed were medically necessary, announced United States Attorney Richard S. Hartunian. As part of the settlement, Borio admitted that he and others submitted claims to Medicare that are unsupported by his records. He also agreed to implement additional compliance measures as a condition of his continued participation in Medicare and other federal health care programs.
In 2009, federal authorities received information suggesting that Borio had engaged in questionable billing practices. A subsequent investigation revealed that, from May 4, 2006 through April 9, 2008, Borio submitted 10,534 claims for payment to Medicare, which is far more than any other chiropractor in 45 upstate and central New York counties. He also billed for treating as many as 69 Medicare beneficiaries in a given day. Taking into account both Medicare and non-Medicare patients, Borio sometimes billed for personally treating hundreds of individuals in a single day. Of the claims Borio submitted to Medicare during this period, more than 99.9% were billed using the highest-reimbursing billing code (other chiropractors in the region billed that code, on average, just over 13% of the time). During this period, Borio billed that code nearly three times more than the region’s next highest biller. He also treated his Medicare beneficiaries, on average, almost three times more frequently than his peers.
* * *
