Texas Pain Doctor Pay $390K Fine

[drusso]

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A Houston pain management physician agreed to pay $390,082 to settle allegations that he submitted false Medicare claims for surgical implantation of neurostimulator electrodes, the Justice Department said in a June 3 release.

What happened?

• Between Dec. 7, 2021, and Dec. 14, 2022, Benjamin Tiongson, MD, allegedly billed Medicare for surgical implantation procedures that were never performed.
• Instead, patients reportedly received electro-acupuncture devices that involved inserting monofilament wires just a few millimeters into the ear, with the device taped behind the ear using adhesive.
• All procedures took place in Dr. Tiongson’s clinic, not a hospital or ASC and no incision was made.

 

[Ducttape]

Houston doctor pays six figures to settle False Claims Act liability involving neurostimulator devices

A 68-year-old Houston man has agreed to pay $390,082 to resolve allegations he submitted false claims to Medicare for the surgical implantation of neurostimulator electrodes

www.justice.gov

 

[Laryngospasm]

Sounds legit

 

[cowboydoc]

Primum non nocere.

In related news, @Agast has a new frontrunner in the locum candidate race.

 

[sloh]

Wonder who the whistleblower was

 

[22yis]

Wonder who the whistleblower was

Angry friend of a pill for poke patient that had his insurance denied

 

[jsaul]

I know this doc. I am sure the same slimy reps who convinced him to do this came to my office as well and tried numerous times to get me to do this. I declined every time and banned them from stepping foot into my office again

 

[Agast]

Primum non nocere.

In related news, @Agast has a new frontrunner in the locum candidate race.

I bet I could get him for cheap, too!

The wild thing is a bunch of other pain docs in this area got nailed before he started doing this. Does he not read the news? The first I recall was 2020

Pain doctor pays to settle allegations of deceptive Medicare billing

A 52-year-old pain management physician from Houston has paid $530,000 to resolve allegations he falsely billed Medicare for the use of electro-acupuncture devices

www.justice.gov

Woodlands pain doctor pays half million dollars for fraudulent PPP and billing allegations

A 49-year-old local physician has agreed to pay $523,331 to settle allegations he submitted false claims for the placement of electro-acupuncture devices and for making false statements when applying for a loan from the Paycheck Protection Program (PPP)

www.justice.gov

It’s also amazing there’s no blowback on these companies knowingly pitching fraudulent devices that have a track record of getting the doctors into trouble, because they would have known about all the pending lawsuits

 

[ghost800]

I know this doc. I am sure the same slimy reps who convinced him to do this came to my office as well and tried numerous times to get me to do this. I declined every time and banned them from stepping foot into my office again

This exact thing happened to me with a rep for what I think is the exact same device about 3 years ago. I politely declined.

 

[BobBarker]

@Agast here is another one from 2021. Good guy, fun to hang out with. One of my very sr residents.
Pain doctor pays to settle allegations arising from false billing

 

[Agast]

@Agast here is another one from 2021. Good guy, fun to hang out with. One of my very sr residents.
Pain doctor pays to settle allegations arising from false billing

Anyone ask him what he was thinking?

I’m pretty sure this device has been reborn as the “nerve stimulator to fight addiction” that I’ve been seeing ads for in the pain magazines

 

[plasma.]

In such cases, apart from settling for those amounts, do these physicians also get college complaints, do they get fired from their positions etc?

 

[gaseous_clay]

I know this doc. I am sure the same slimy reps who convinced him to do this came to my office as well and tried numerous times to get me to do this. I declined every time and banned them from stepping foot into my office again

I understand it’s the physician’s ultimate responsibility to vet these things out, but I don't see why reps who promote fraudulent schemes like this aren’t held personally liable by regulatory bodies.

 

[mygalperin]

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I bet I could get him for cheap, too!

The wild thing is a bunch of other pain docs in this area got nailed before he started doing this. Does he not read the news? The first I recall was [emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji6]][emoji[emoji6]]][emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji6]][emoji[emoji6]]]

Pain doctor pays to settle allegations of deceptive Medicare billing

A 52-year-old pain management physician from Houston has paid $530,000 to resolve allegations he falsely billed Medicare for the use of electro-acupuncture devices

www.justice.gov

Woodlands pain doctor pays half million dollars for fraudulent PPP and billing allegations

A 49-year-old local physician has agreed to pay $523,331 to settle allegations he submitted false claims for the placement of electro-acupuncture devices and for making false statements when applying for a loan from the Paycheck Protection Program (PPP)

www.justice.gov

It’s also amazing there’s no blowback on these companies knowingly pitching fraudulent devices that have a track record of getting the doctors into trouble, because they would have known about all the pending lawsuits

Somebody who graduate from college and medical school should know better, this a difference between medicine and bullsheet, no rep should convince a doctor, unless he is hungry for money. Same thing will happened for billing for stim trials!

 

[Ducttape]

in their defense, it could be that they perform the procedure, are told by the rep what billing code to use and just submit it without realizing that the codes are incorrect and dont correspond to the procedure.


then they see how much the incorrect procedure "reimburses" and they are captured by their avarice.

take home message - reps are not our friends. do the research.

 

[lobelsteve]

in their defense, it could be that they perform the procedure, are told by the rep what billing code to use and just submit it without realizing that the codes are incorrect and dont correspond to the procedure.


then they see how much the incorrect procedure "reimburses" and they are captured by their avarice.

take home message - reps are not our friends. do the research.

Stupidity is not a defense.
Knew or should have known.

 

[Ducttape]

au contraire - stupidity is a defense.


it just doesnt work when it matters, like court of law.

 

[PinchandBurn]

Stupidity is not a defense.
Knew or should have known.

How about those that used StimWave?

It appears theres controversy about Nalu coding too..

Some think even for the minuteman there is as well.

 

[lobelsteve]

How about those that used StimWave?

It appears theres controversy about Nalu coding too..

Some think even for the minuteman there is as well.

Sham treatments with KOL research.

 

[Taus]

Sham treatments with KOL research.

I have “heard” many man uses the same fusion codes as the surgeons. I’m really not familiar with this… What fusion code is it equivalent to?

 

[Agast]

I have “heard” many man uses the same fusion codes as the surgeons. I’m really not familiar with this… What fusion code is it equivalent to?

It’s the same code as the standard posterior fusion done with rods and screws

 

[Agast]

Based on records coming from two prolific pain docs, my understanding of how to maximize your billing off a Medicare patient looks like this:

Lumbar MBB, Lumbar MBB
SI joint injection x2
SI joint fusion x2 (different days of course)

Notice the avoidance of an epidural steroid injection that might actually give the patient relief

 

[RoloTomassi]

I have “heard” many man uses the same fusion codes as the surgeons. I’m really not familiar with this… What fusion code is it equivalent to?

 

[buddababa]

View attachment 404764

jeez, no wonder pain docs wanna do this, one procedure pays more than a whole day of clinic/procedures etc

 

[RoloTomassi]

jeez, no wonder pain docs wanna do this, one procedure pays more than a whole day of clinic/procedures etc

I think it's iffy calling this a fusion. 70 RVUs for this is crazy. Wouldn't be surprised if a claw back happens.

 

[SgtThunderfistMD]

Based on records coming from two prolific pain docs, my understanding of how to maximize your billing off a Medicare patient looks like this:

Lumbar MBB, Lumbar MBB
SI joint injection x2
SI joint fusion x2 (different days of course)

Notice the avoidance of an epidural steroid injection that might actually give the patient relief

But why would an epidural even be relevant here? Lumbar MBB and SIJ are for axial pain. If axial pain, I don't do epidurals.

 

[Agast]

But why would an epidural even be relevant here? Lumbar MBB and SIJ are for axial pain. If axial pain, I don't do epidurals.

It’s relevant because they don’t actually have axial pain

Actually the one time someone did have axial back pain, she got the lumbar ESI and then the SI joint fusion work up

it’s about withholding relief until you can milk their insurance for every procedure

 

[mdo1738]

I think it's iffy calling this a fusion. 70 RVUs for this is crazy. Wouldn't be surprised if a claw back happens.

Work RVU is only 35, so only half as lucrative as it seems at first glance. Still easily the highest RVU per minute of procedure time I’m aware of. I’m sure there are clawbacks, I have not heard of any though. It may not meet the spirit of the code, but it does meet the letter. I offer it to people with grade 1 spondy and central stenosis clearly worst at that level who absolutely refuse neurosurgical eval. Very good results with my stringent selection criteria, do 1 about every 2-3 months. Another procedure that gets a bad name from those who use it on every patient they can get a PA approved on.

 

[BobBarker]

MM is a good procedure. Fun, helpful, small
wack

 

[mdo1738]

MM is a good procedure. Fun, helpful, small
wack

Excellent arm workout as well

 

[PinchandBurn]

MM is a good procedure. Fun, helpful, small
wack

100% agree
I do maybe 1 or 2 a month. If appropriate. All good to a nsg first for evaluation.


Its not pwrfect but on carefully selected people its perfect.

 

[BobBarker]

I have done 3 since the first of the year. But I will end up doing more since Vflex is gone.

 

[BoardingDoc]

100% agree
I do maybe 1 or 2 a month. If appropriate. All good to a nsg first for evaluation.


Its not pwrfect but on carefully selected people its perfect.

You and @BobBarker seem to be doing more of these than most people here. Our fellowship doesn't do them. What's your target patient population/pathology/thought process behind doing MM vs something else?

 

[22yis]

You and @BobBarker seem to be doing more of these than most people here. Our fellowship doesn't do them. What's your target patient population/pathology/thought process behind doing MM vs something else?

MIST guidelines is a good place to start

 

[lobelsteve]

MIST guidelines is a good place to start

A veritable who's who in ****** for industry.

 

[BobBarker]

Since vertiflex is off the table, MM is the least invasive of the options. Since you do it through a port a surgery on a morbidly obese person isn’t more difficult than a normal fluffy elderly person. The posterior spacers are a lot of surgery on big people.

 

[Gnarvin]

Since vertiflex is off the table, MM is the least invasive of the options. Since you do it through a port a surgery on a morbidly obese person isn’t more difficult than a normal fluffy elderly person. The posterior spacers are a lot of surgery on big people.

Admittedly, I am thinking of doing some MM now that Vertiflex is off the table. Do you run in to issues with the ilium getting in the way for the lateral approach at the lower lumbar levels? If so, how do you work around that?

 

[BobBarker]

I never have. But I’m good at head math.

 

[BobBarker]

I palpate the ileum and usually make my incision just over it and then guide the wire posterior to anterior, lateral to medial to bullseye just posterior to lamina when i cross over to the opposite side.

 

[soccrwz]

Admittedly, I am thinking of doing some MM now that Vertiflex is off the table. Do you run in to issues with the ilium getting in the way for the lateral approach at the lower lumbar levels? If so, how do you work around that?

start more cephalad at L4 with high riding iliac crest you can go slightly diagonal through interspinous ligament and the device will situate it self and self correct when clamping

 

[BoardingDoc]

I was talking to someone last night about MM and they said they didn't do them because reimbursement was getting clawed back frequently in the past. Not sure if you guys are running into similar.

 

[BobBarker]

The only case I know that never paid for me was a situation where the surgical hospital had chosen to credential as an ASC for Medicaid only. So I did the case at the HOPD that was credentialed as an ASC and Medicaid doesn’t cover 22612 at ASC. I got paid my professional fee.