The government is building an aggressive case against physicians and medical practices who received payment from the Centers for Medicare and Medicaid Services (CMS) for treating patients with amniotic fluid injections like Fluid Flow treatments. The agency has sent out letters demanding repayment of these funds. The feds are going through this process, referred to as a claw back, and has also started investigating practices throughout the country.
What types of treatments are the subject of scrutiny?
Physicians would use these amniotic fluid injections to treat inflammation and joint pain. Physicians prescribed these injections for treatment of patients with various injuries and diseases such as arthritis and spinal injury.
Treatment was touted as an excellent way to help patients recover but came with a high cost. Each individual injection generally resulted in a $2,000 bill. This could quickly add up to thousands of dollars — meaning practices who received payment for these treatments could face millions of dollars in claw back demands from the federal government.
How is the government building their case?
They note that the codes available for practices to use to bill the CMS for these services, such as Q4206, were not a guarantee the government had cleared treatment for use in patients.
As such, the feds claim use of this temporary code did not guarantee coverage.
Is there anything else I should know?
During an investigation, the CMS may collaborate with the Department of Justice (DOJ). This means there could also be allegations of Medicare fraud and the potential for criminal charges.
How should I respond if I get one of these demand letters?
Prepare a response and begin building a defense. These allegations are serious and physicians should take them as such. An attorney experienced in healthcare law matters such as these can provide guidance and work to protect your interests throughout the process — from initial investigation to litigation, if necessary.
Attorney John Rivas is responsible for this communication