Penn. practice tries to charge Medicare for P-Stim, will pay $178K

by: Roy Edroso Sep 18, 2019

Medicare doesn't pay for "P-stim," but this Willow Street, Pa., provider gave it shot, and is now paying the feds $178,000 to get out from under a False Claims Act rap.

U.S. Attorney for the Eastern District of Pennsylvania alleges that from May 2013 through June 2014 Richard P. Frey, DO, and Physicians Alliance Ltd. (PAL) of Willow Street, Pa., charged Medicare for use of the device on their patients.

"P-Stim," First Assistant U.S. Attorney Jennifer Arbittier Williams informs us in a press release announcing the government's settlement with Grey and PAL, "is an electric acupuncture device that, pursuant to manufacturer’s instructions, is affixed behind a patient’s ear using an adhesive. Needles are inserted into the patient’s ear and affixed using another adhesive. Once activated, the device then provides intermittent stimulation by electrical pulses."

The user is supposed to wear this thing until its battery runs out, about four days after it's switched on, and then throw it away.
As there has been no determination of civil liability, there's no public record of this case, so we don't know exactly what codes Grey used -- the release says he billed for "implantation of neurostimulator electrodes," for which there are over a dozen HCPCS codes.

But Medicare administrative contractor CGS tells providers that "this item is not reimbursable by Medicare. Claims submitted to the DME MACs for the P-stim® device must be coded A9270 (Noncovered item or service)."

Blog Tags: compliance, OIG

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