Two Dermatology Providers To Pay $847K+ To Resolve Medicare Coding Fraud Claims For Wound Care Under the False Claims Act
By the Constantine Cannon听Whistleblower Team
Forefront Dermatology S.C. (鈥�Forefront鈥�) and Henghold Surgery Center LLC (鈥�Henghold Surgery Center鈥�) will pay $847,394 to resolve allegations that they violated the False Claims Act by submitting falsely coded claims to Medicare for wound repairs.
The Dermatology Providers and the Procedures Allegedly Performed
Forefront owns and operates Henghold Dermatology, a dermatology practice in Florida. 听Dr. William B. Henghold owns an ambulatory surgery center, Henghold Surgery Center, which closed in 2023. Both facilities allegedly performed numerous wound repair procedures following skin cancer removal on patients who had undergone Mohs micrographic surgeries.1
Submission of False Claims to Medicare
The government alleges that Henghold Dermatology and Surgery Centers caused the submission of false claims to Medicare by using inaccurate wound repair billing codes. As a result, Medicare paid more money than it normally would have for wound repairs.2 This Medicare fraud scheme is known as upcoding.
According to the DOJ, Henghold Dermatology and Surgery Centers 鈥渇alsely coded linear repairs as if they were flap repairs and falsely coded smaller flap repairs as if they were larger flap repairs.鈥�3
鈥淪chemes that cause Medicare to pay for costlier services than were actually performed waste taxpayer funding, threatening the integrity of this federal healthcare program,鈥� said Deputy Inspector General for Investigations Christian J. Schrank of the U.S. Health and Human Services Office of Inspector General (HHS-OIG).4
This case bears some resemblance to a healthcare fraud settlement we blogged about earlier this year. In April, the government announced it filed a complaint under the听False Claims Act听against Vohra Wound Physicians Management LLC (Vohra), its entities, and its founder Dr. Ameet Vohra. Among other violations, the government alleged the company submitted false claims to听Medicare听for听upcoded and听medically unnecessary听wound care services.
Healthcare Fraud
Healthcare fraud can take many forms including taking听kickback听payments for services or patient referrals, billing for medically unnecessary services, upcoding, making false statements about covered services, and more. It is critical to recognize fraud and speak up against misconduct.
The Role Whistleblowers Play in Exposing Healthcare Fraud
This settlement includes the resolution of claims brought under the听qui tam听(or whistleblower) provisions of the False Claims Act by a former Forefront employee and whistleblower, Christopher Wolfe, M.D. Under the False Claims Act, private parties can file lawsuits on behalf of the government and receive up to 30% of any recovery. The whistleblower, Dr. Wolfe, will receive a $152,531 share of the settlement.
Our Firm Helps Healthcare Fraud Whistleblowers
鈥淗olding healthcare providers accountable for fraud protects our tax dollars, ensures patients receive proper care, and upholds the integrity of federally funded programs like Medicare,鈥� said 91pornattorney Dan Noel.
91pornhas over 15 years of experience representing healthcare fraud whistleblowers. Please听contact听us if you believe you have a case.听We will connect you with an experienced member of the 91pornwhistleblower听team听for a free and confidential consultation.
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Tagged in: False Claims Act, Healthcare Fraud, qui tam,