Dialysis Center Agrees to Pay $4.36 Million to Settle Allegations that it Overbilled for Physician Services

On May 3, 2012, the U.S. Attorney’s Office for the Eastern District of Tennessee announced that a number of dialysis centers in the Knoxville, Tennessee area had agreed to pay $4.36 million to resolve allegations that they had violated the federal False Claims Act, the Tennessee Medicaid False Claims Act and other federal and state laws and regulations.

An investigation conducted by the U.S. Department of Health and Human Services – Office of the Inspector General, FBI, area federal prosecutors, the Tennessee Bureau of Investigations and the Tennessee Valley Authority Office of Inspector General revealed that from at least 2001 through 2006, Apex Medical Group, doing business as Nephrology Consultants and affiliated dialysis centers had submitted inaccurate claims to government health programs, including Medicare and TennCare, for a variety of dialysis services.  These inaccurate requests for payment took the form of upcoding for physician services whereby a medical provider submits a bill for a particular procedure when a less expensive type of treatment was actually provided.

According to the U.S. Attorney’s office, Apex Medical Group has agreed to compensate the federal and state governments for its improper billing practices.

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