Coding Expert to Pay Over $15 Million in Fraudulent Billing Case

Sarasota, FL (WorkersCompensation.com) – You may want to be extra careful when seeking coding and compliance consults, according to a recent announcement from the Eastern District of Pennsylvania Department of Justice.

Earlier this week, U.S. Attorney Jacqueline Romero announced a default judgment of over $15 million against Timothy Warren, a coding and compliance consultant that also owned Titan Medical Compliance, LLC for violations of the False Claims Act. The judgement came as the result of findings in a national level investigation into improper billing of neurostimulators, also known as P-Stim devices.

P-Stim devices are commonly marketed under ANSiStim, Stivax, NeuroStim, and NSS-2 Bridge. These types of devices are external stimulators that are designed to be attached to the body and deliver an electrical stimulation through the skin and are often used for pain via chiropractic or acupuncture therapy.

For many years, Medicare considered neurostimulators and acupuncture as experimental and medically unnecessary. In the wake of the opioid epidemic, Medicare changed their position and issued a coverage policy in the face of a need for a pain management alternative. However, due to misinformation paired with a lack of clarity, Medicare had to revise their policy and specify further. The result was that only implantable spinal nuerostimulators are considered medically necessary.

Since the fallout of the coverage revisions, Medicare found on audit that over $1.4 billion was paid out in error due to improper coding. In most cases, providers were billing for a surgical implant code when the electrical stimulation actually occurred the through skin.

Any time a new device hits the market, physicians depend on manufacturers and their representatives or consultants for guidance on compliance and how to bill. In the case of Timothy Warren, who is also a chiropractor in Wichita, Kansas, Warren was that person that providers looked to for counsel on how to bill for nuerostimulator devices that were not implanted.

Starting in 2014, Warren allegedly promoted P-Stim devices as considered medically necessary and covered by Medicare when in fact he had knowledge that they were not. Investigators allege over 1,200 fraudulent claims were filed as a result of his coding and compliance consultations. In October of last year, the U.S. Attorney’s Office for the Eastern District of Pennsylvania filed a Complaint against Warren. In the course of litigation, Warren requested that the case be moved to Kansas but was defeated. The Department Of Justice moved for a default judgement after Warren’s counsel withdrew and related defendants failed to respond.

Warren and his company Titan are now responsible to pay out $15,270,066 as a result of the judgement.

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