Suffield Doctor Settles Billing Lawsuit

A Suffield doctor has agreed to the civil settlement of a lawsuit filed by the U.S. Attorney’s office on charges of improper Medicare billing by repaying the federal government fees worth $379,764.

The suit claimed Dr. William J. Garrity, a practitioner of osteopathic medicine, had improperly billed Medicare for patient office visits between 2002 and 2009, according to a press release from the U.S. Department of Justice (DOJ). The extra billing was considered a violation of the False Claims Act. Garrity, who practices in Suffield at 230B Mountain Road, did not admit any liability as a condition of the settlement.

Garrity’s practice provides both traditional and osteopathic medical service, which involves manipulating joints and bones to treat musculoskeletal disorders. The DOJ said that approximately 95 percent of visits by Medicare-eligible patients to Garrity’s practice for osteopathic treatment resulted in Medicare being billed for that treatment as well as a separate evaluation and management service (office visits).

“Medicare does not normally allow additional payments for evaluation and management services performed by a provider on the same day as a procedure because it is expected that most procedures involve some pre-procedure and post-procedure care that is part of the payment for that procedure,” the DOJ’s release said.

Garrity used a billing modifier called Modifier 25 to bill Medicare for both osteopathic and office visits on the same visit. The DOJ’s release said the use of Modifier 25 is allowed when the evaluation and management service provided is “significant, separately identifiable, and above and beyond the usual pre-procedure and post-procedure care.”

The suit alleged that a review of Garrity’s records found a lack of documentation to justify the use of the Modifier 25 billing practice. According to DOJ’s release, the suit also alleged that the results of the evaluation and management services billed for under the modifier weren’t documented.

“Gaming the Medicare reimbursement system depletes the government’s health care resources,” U.S. Attorney David B. Fein said in the release. “Health care fraud is a serious national problem that the United States Attorney’s Office is committed to combating here in Connecticut.”

Garrity entered into a billing integrity agreement with the U.S. Department of Health and Human Services as a condition of the settlement. The agreement will enforce compliance with Medicare billing practices, according to the DOJ.