Medical Fraud Case Settled Between Norwich Doctor And Feds

NORWICH, CT — A Norwich physician has settled a civil lawsuit with the government and will $99,912 to resolve allegations that he falsely billed Medicare and Medicaid, violating the False Claims Act, announced United States Attorney John H. Durham Wednesday.

Helar Campos, MD, has practices in both Norwich and New London and was accused of fraudulent billing for evaluation and management ("E&M") services, commonly referred to as physician office visits.

"The government alleges that Campos submitted claims to Medicare and Medicaid for E&M services that were not performed in accordance with program requirements," according to Durham's release. "The government alleges that Campos 'upcoded' certain office visit services, submitting claims to Medicare and Medicaid by using a higher-paying billing code when services with lower-paying billing codes were actually provided. Specifically, the government alleges that Campos submitted claims for E&M services under CPT code 99214 when he should have submitted the claims under CPT code 99213 or 99212, which are less complex services, reimbursed at a lower rate."

To resolve his liability under the False Claims Act, Campos' payment will reimburse the Medicare and Medicaid programs for conduct occurring from January 1, 2009, through December 31, 2012.

Under the False Claims Act, the government can recover up to three times its actual damages, plus penalties of $11,181 to $22,363 for each false claim.

This case was investigated by the Office of Inspector General for the Department of Health and Human Services. The case was prosecuted by Assistant U.S. Attorney Anne F. Thidemann with the assistance of Auditor Kevin A. Saunders.

U.S. Attorney Durham encouraged individuals who suspect health care fraud to report it by calling the Health Care Fraud Task Force (203) 785-9270 or 1-800-HHS-TIPS.

Image via Shutterstock

To sign up for Norwich breaking news alerts and more, click here.