On October 13, 2020, Advanced Pain Management Specialists, P.A. (Advanced Pain), based in Fort Myers, Florida, entered into a $24,921.96 settlement agreement with the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) to resolve allegations of Civil Monetary Penalties (CMP) law violations Office of Inspector General.

Alleged Violation

The OIG alleged that Advanced Pain submitted claims to Medicare for specimen validity testing (SVT) in conjunction with claims for urine drug testing when SVT was a non-covered service under Medicare rules Office of Inspector General. Submitting such claims for non-covered services is a prohibited act under the CMP law, which can result in financial penalties and potential exclusion from federal healthcare programs.

Enforcement Context

• Enforcement Types: Civil Monetary Penalties (CMP) and Affirmative Exclusions Office of Inspector General.
• Resolution: The settlement was reached without a finding of liability; the company contested the allegations and denied any wrongdoing oig-kan-dns1.oig.hhs.gov.
• Parties Involved:
  • OIG Offices: Office of Audit Services and Office of Counsel to the Inspector General.
  • Legal Team: Senior Counsels Andrea Treese Berlin and Gregory Becker, with Paralegal Specialist Jennifer Hilton Office of Inspector General.

Significance

This case is part of OIG’s broader enforcement of Medicare rules against improper billing, including affirmative exclusions—where certain services are explicitly excluded from coverage and cannot be billed for. Violations can lead to:

• Financial penalties (CMPs) such as the $24,921.96 payment in this case.
• Exclusion from federal healthcare programs if the violation is severe or repeated.
• Potential criminal charges in cases involving fraud.

For healthcare providers, this underscores the importance of ensuring all billed services are medically necessary and covered under applicable federal and state regulations to avoid costly settlements and program exclusions.