California Physician and Practice Settle False and Fraudulent Claims Case

On April 12, 2019, Complete Women Care, Inc., and Miriam Mackovic-Basic, M.D. (collectively, “CWC”), with multiple locations in Los Angeles County, California, entered into a $258,045 settlement agreement with OIG. The settlement agreement resolves allegations that CWC submitted claims to Medicare for items or services that it knew or should have known were not provided as claimed and were false or fraudulent. Specifically, OIG contended that CWC submitted claims for: (1) diagnostic electromyography services using CPT Code 51784 and diagnostic anorectal manometry (ARM) services using CPT Code 91122 when therapeutic, not diagnostic services, had been provided; (2) ARM services using CPT Code 91122 that were not performed according to CMS guidelines; (3) pelvic floor electrical stimulation that was not preceded by a four-week course of failed pelvic muscle exercise training; and (4) in 13 instances, evaluation and management services using CPT Code 99214 that did not meet the criteria for billing under that code. OIG’s Division of Data Analytics and Office of Counsel to the Inspector General, represented by Senior Counsels David Traskey and Michael Torrisi, with the assistance of Program Analyst Mariel Filtz, collaborated to achieve this settlement.

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