The owner and operator of a New Jersey billing company will pay a $100,000 penalty after submitting fraudulent Medicare claims for diagnostic tests that were never conducted, marking the first such penalty for a billing company from HHS' Office of Inspector General.
Susan Toy and her company, Millennium Billing, submitted claims to Medicare for a physician-owned obstetrics and gynecology practice, knowing that the underlying diagnostic tests were never performed, according to the OIG. She received compensation from the practice—the Center for Advanced Pelvic Surgery—for these actions.
The first-of-its-kind penalty, HHS OIG spokesman Donald White said, demonstrates that OIG expects "compliance throughout the full range of federal healthcare program processes.”
According to OIG's investigation, Toy received a superbill from the practice documenting pelvic floor therapy services conducted by medical assistants that included codes for provided care. But Toy routinely added additional codes for unperformed services before submitting reimbursement requests to Medicare. In particular, she used a code for anorectal manometry, even though that diagnostic test was not conducted.
In addition to the financial penalty, Toy will be excluded from federal healthcare programs for the next five years, the OIG said.