​Medicare Billing Mistakes, Expensive Consequences

​One of the most important administrative aspects of successfully running a clinic involves accurate Medicare billing. It requires excellent attention to detail and a thorough, up-to-date understanding of the latest regulations and procedures. It’s not an area of your clinic where you want to make any mistakes. One clinic recently found this out the hard way and has reaped expensive consequences. 

More specifically, two medical doctors are facing fines of $181,758 to resolve mislabeling associated with the billing of Sanexas devices. In mid-June, US Attorney Jennifer Arbittier Williams made this announcement, naming Thomas Rocchio, DPM, and Adam Teichman, DPM, of PA Foot & Ankle Associates, LLC. As co-owners of the practice, Roccio and Teichman are both podiatrists with office locations throughout Pennsylvania. 

Here's what you need to know about this stunning development and what it means for your practice. ​

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PA Foot Therapeutic Protocol

​Between September 2019 and March 2021, Rocchio and Teichman submitted more than 7,000 claims for payment to Medicare. These claims involved the application of RST Sanexas neoGEN-Series devices coupled with vitamin injections. PA Foot used Sanexas to treat medical conditions and pain stemming from peripheral neuropathy. Comprised of a large central unit, the Sanexas device includes electrical leads, which the practitioner temporarily attached to the area targeted for treatment. 

Treatment times lasted between 30 and 40 minutes, with patients participating in sessions on an outpatient basis. The protocol typically involved two treatments per week over 12 weeks for a total of 24 sessions. To complement the Sanexas device treatment, PA Foot administered vitamin injections.

The Problem with PA Foot and Sanexas

According to National Coverage Determination 160.7.1, electrical nerve stimulation devices are exempt from coverage. What’s more, Local Coverage Determination L35456 explains, “[T]he use of electrostimulation alone for the treatment of multiple neuropathies or peripheral neuropathies caused by underlying systemic diseases is not medically reasonable and necessary.” But the problems faced by PA Foot didn’t stop there. 

While the US Food and Drug Administration had declared the Sanexas device similar to a transcutaneous electrical nerve stimulator (TENS) in January 2003, it had never been cleared for patients in conjunction with vitamin injections. These injections did not fall under the coverage for prescription drugs as outlined under Medicare Part B. What’s more, numerous regulations had already declared that vitamin injections were not deemed “medically reasonable and necessary” for use as nerve blocks. ​

Medicare Billing Mistakes 

This case underscores the importance of accurately billing Medicare beneficiaries for services provided. The US Attorney’s Office remains dedicated to investigating and pursuing instances of inaccurate billing of Sanexas and devices like it. As Chiquita Brooks-LaSure explains, “Patient care and safety are top priorities for us, and every dollar saved is critical to the sustainability of our Medicare program and the needs of our beneficiaries.” Fortunately, Dr. Teichman and Dr. Rocchio proved willing to work with the US Attorney’s Office to quickly resolve the matter. 

If your clinic is looking for a better way to address the symptoms of peripheral neuropathy, we can help. Contact us today to learn more about the NeuropaCalm Care Program and the science behind it.