IN Ortho Surgery Center Pays $700K to Settle Fraud Claims

The State of Indiana, acting through the Office of the Indiana Attorney General’s Medicaid Fraud Control Unit (Indiana), has entered into a $700,000 settlement with Southeastern Medical Center (SEMC), a medical group practice based in Hammond, Indiana that specializes in orthopedic surgery.

The settlement addresses allegations that an orthopedic surgeon overbilled the Indiana Medicaid Program.

The State of Indiana had claimed that between “January 1, 2016, and June 1, 2021, SEMC submitted claims to Indiana Medicaid for ‘Spinal Manipulation under Anesthesia.’” Indiana alleged that “SEMC was not providing spinal manipulation under general anesthesia as required” under the CPT code. Additionally, Indiana alleged that “documentation for numerous patients did not support that spinal manipulations were occurring at all.” Indiana further claimed that the submissions constituted the submission of “false or fraudulent claims to the Indiana Medicaid Program.”

According to Indiana’s Attorney General’s office, Kishan Chand, M.D. is an orthopedic surgeon and operates SEMC, had, during the five year period, purportedly “submitted approximately 13,101 claims indicating that medical staff performed spinal manipulation on patients who were under anesthesia.”

In the Settlement Agreement, SEMC did admit that the claims were not performed under general anesthesia. However, SEMC denied that the claims were false claims and denied that it engaged in any wrongdoing in connection with the allegations. Indiana and SEMC entered into the settlement agreement to avoid the “delay, expense, and uncertainty associated with litigation.”

The $700,000 settlement includes $465,419.52 in restitution and $234,580.48 in additional recoveries. The entire payment is due within 60 days of the effective date of the Settlement Agreement.

In the press release, Attorney General Todd Rokita said, “Physicians and other providers have an ethical and legal obligation to accurately report medical procedures for which they seek Medicaid reimbursement.”

Rokita continued, “My office will continue to ensure citizens’ tax dollars are protected from fraud and abuse by vigorously pursuing providers who have been unjustly enriched through improper billing.”