A Stratford, Connecticut doctor has decided to settle rather than go through an extensive trial and accompanying costs related to allegations of fraudulently billing Medicare for services rendered at area nursing homes.
The United States Attorney for the District of Connecticut brought allegations against Dr. James Ralabate and his company, Primary Care Associates, involving fraudulent billing to Medicare occurring throughout a five-year period for medical services provided at various nursing homes, according to a release.
Ralabate allegedly billed Medicare for high-level physician services when the services of a physician were not medically necessary, and medical records fail to meet the detailed history, examination, or medical decision-making requirements necessary to justify the high level of physician care, the attorney’s office said. Additionally, at times, no medical record documented Ralabate’s visit.
The government also accused Ralabate of billing Medicare for services supposedly rendered to patients in nursing homes when those patients weren’t actually present in the nursing homes but rather had been transferred to local hospitals for treatment. Despite a difference in locations, Ralabate billed government healthcare programs as if he had provided medical services in the nursing homes.
The alleged fraudulent billing activity took place between Jan. 1, 2006 and Aug. 31, 2011. Although Ralabate and his company agreed to pay $700,000 in order to reimburse the Medicare programs and resolve liability under the False Claims Act, the physician denies wrongdoing.
“Prior detailed audits by CMS proved that only 2 out of 54 procedures/services studied were coded higher than the documentation supported and only 1 was thought to be for more services than necessary, while 14 were actually under-coded,” says a statement from Ralabte’s office. “Even though he provided more services than his peers, 98.2 percent of the services studied extensively were found to be medically necessary. This prior audit actually resulted in increased payments to Dr. Ralabate.”
Only after Ralabate learned that an audit had found his medical services records to be “beyond what Medicare pays for” did he choose to settle the case, “rather than take time away from his patients and pay legal bills for the trial,” his office says in the statement.
The doctor also responded to the allegations that he billed Medicare for nursing home services while patients were in the hospital, saying that he did in fact visit and provide his services to those nursing home patients and never billed for services that were not provided.
“The financial settlement was only based upon the Government’s belief that some health services were miscoded, or provided more care than Medicare would pay for,” says the statement from Ralabate’s office, and the doctor has chosen to hire billing and coding experts to prevent any risk of noncompliance.
Written by Alyssa Gerace