Multi-physician practice groups plead guilty to mail fraud

TRAVERSE CITY – Traverse Anesthesia Associates, PC, and Pain Consultants, PC, have pleaded guilty to one count of mail fraud for double billing insurance companies for certain medical procedures, according to the U.S. Attorney’s office for the Western District of Michigan. They will be sentenced on Sept. 17.

The government alleged that Traverse Anesthesia billed health care insurers for anesthesia services that included IV starts, and then Pain Consultants separately billed insurers for the same IV starts.

“As a result, the group of physicians that comprised both Traverse Anesthesia Associates and Pain Consultants were paid twice for each such IV start,” according to a statement from the U.S. Attorney’s office.

Under the plea agreement, both companies will pay restitution of $179,134.74 and a criminal fine of $143,307.79.

In addition, the companies have agreed to resolve civil charges alleging they falsely billed Blue Cross Blue Shield Michigan for IV starts, falsely billed Medicare for physician supervision of anesthesia services provided by certified registered nurse anesthetists (CRNA), when there was no supervision, and that they falsely billed Medicare for CRNA services at two times the appropriate rate.

According to a written statement from the office of Traverse Anesthesia Associates and Pain Consultants, the settlement agreement “does not include sanctions against any individual physician or any of the groups’ 24 employees. Moreover, the settlement relates to billing practices only and not to the quality of patient care provided by the physicians and nurses of TAA and PC.”

The statement says that the companies are “making improvements in their billing procedures to comply with complex federal and nonfederal payor regulations and to prevent overpayments in the future.”

It further says that the companies have “accepted responsibility for the previous billing practices by cooperating with government investigators and agreeing to pay the applicable fine and make restitution.” The companies are located at 1221 6th St. in Traverse City. BN