A $2.1 million civil resolution has been made by Allergy and Asthma Associates Inc. (AAA), a family-owned medical practice in Virginia, after failing to administer or falsely billing over $600,000 worth of asthma treatments. AAA also pleaded guilty to criminal charges of healthcare fraud in October of last year.
The resolution follows a lengthy interagency investigation by the Department of Health and Human Services, Virginia Office of the Attorney General’s Medicaid Fraud Control Unit, and the Federal Bureau of Investigation. Court documents showed that AAA had submitted improper billings to Medicare and Medicaid for Xolair, an expensive medicine for asthma patients for nearly a decade. Between January 2010 and September 2017, AAA billed Medicare $627,540 for Xolair that had not been purchased, due to a vial dosage loophole.
Xolair is sold in single-use vials. However, many patients only require a partial dose of the vial, which results in leftover amounts of the drug that remain unused. Medicare and Medicaid allowed providers to bill Medicare Part B and Medicaid one time for an entire single vial of Xolair, which includes both the administered quantity as well as the discarded quantity of the drug from a single-use vial, up to the amount listed on the vial’s label. The investigation found that AAA had frequently administered the leftover Xolair from one vial to another patient but then billed Medicare and Medicaid as if they had administered a new single-use vial, resulting in $88,878 of loss to Medicaid.
According to a press release by the US Department of Justice, “AAA will pay a total of $2,149,607 to settle charges that they violated the false claims act. Broken down, $1,994,607 will be paid to the United States government and $154,648 will be paid to the Commonwealth of Virginia”.
In many cases, medical practitioners may be unwittingly billing insurance companies for incorrect amounts, especially when medications may require partial dosages and the drug’s shelf life allows for administration to new patients. Our attorneys at Padula Law specialize in healthcare fraud and can provide guidance and a strong defense to practitioners that are currently under investigation. Give us a call at (305) 455-5206 to schedule your appointment today.
