CAMDEN, N.J. — A New Jersey pain management clinic with locations in Atlantic, Cape May, and Cumberland counties has admitted to committing health care fraud and has agreed to pay both criminal and civil penalties, U.S. Attorney John Giordano announced Thursday.
Pain Specialists, P.A., which operates offices in Northfield, Vineland, and Cape May Courthouse, pleaded guilty before U.S. District Judge Karen M. Williams to charges of fraudulently billing insurance providers, including Medicare and Medicaid. The clinic also signed a civil settlement with the federal government to resolve allegations of violating the False Claims Act.
According to court documents and statements, Pain Specialists falsely billed insurance companies between November 2015 and January 2020 by submitting claims under the National Provider Identifier (NPI) of a physician specializing in anesthesia and pain management (“Individual-1”). The fraudulent claims were submitted while the physician was traveling and not present to personally provide or supervise treatments. As a result, the clinic received $58,365.26 in improper payments.
Additionally, between January 2014 and November 2020, Pain Specialists allegedly violated Medicare and Medicaid billing regulations by listing a physician as the rendering provider when non-physician practitioners actually performed services without physician supervision.
As part of the plea agreement, Pain Specialists will pay $58,365.26 in criminal restitution, an $81,711.36 criminal fine, and a $240,000 civil settlement. The civil allegations were resolved without an admission of liability.
Federal agencies involved in the investigation included the U.S. Department of Health and Human Services Office of Inspector General, the FBI’s Atlantic City Resident Agency, and the U.S. Drug Enforcement Administration’s New Jersey Division.