ALBANY — A North Country health-care provider has agreed to pay $110,000 for allegedly submitting false claims to Medicare.
Mountain Medical Services billed more than 99 percent of its Medicare services between January 2013 through October 2015 as though the services had been rendered or directly supervised by a physician, Assistant United States Attorney Adam Katz said in a news release.
Mountain Medical and its owner, Dr. Michael Pond, employed physician assistants and nurse practitioners during that period at its urgent care facilities in Lake Placid, Saranac Lake, Malone and Massena, according to the release.
Most of these facilities operated seven days a week, for several hours each day, often without a physician present, the release said.
Medicare reimbursement rules provide higher levels of reimbursement for services rendered by a physician and for services rendered by a nonphysician practitioner who is directly supervised by a physician who not only remains actively involved in the patient’s treatment but is present in the office suite when services are rendered.
“The continued vitality of our federal health-care system depends on honest billing for services,” United States Attorney Grant Jaquith said in the release.
“As this settlement illustrates, we are committed to ensuring that providers who knowingly violate Medicare requirements are held accountable.”
A representative from Mountain Medical did not return a request for comment.
The settlement was entered in connection with a nationwide law-enforcement operation targeting health-care fraud.
“Mountain Medical Services and Dr. Pond, like all health-care providers, must be held to a high standard of ethical behavior,” said Scott J. Lampert, special agent in charge of the U.S. Department of Health and Human Services, Office of Inspector General’s New York Region.
“HHS-OIG will continue to ensure that providers who bill federal health-care programs do so in an honest manner.”
The investigation and settlement were the result of a coordinated effort among the U.S. Attorney’s Office for the Northern District of New York, HHS-OIG and the Federal Bureau of Investigation.
The United States was represented by Katz.
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