TMJ & Orofacial Pain Treatment Centers of Wisconsin, which operates four clinics in the Milwaukee area, has agreed to pay $1 million to the United States to resolve allegations that it submitted to false claims to Medicare and TRICARE for oral appliances used to treat temporomandibular joint disorder (TJD).
The practice and its dentists often prescribe oral appliances to stabilize or reposition patients’ jaws in treating TJD. Yet the US Attorney’s Office of the Eastern District of Wisconsin alleges that they did not fabricate these appliances but purchased them from an outside laboratory that fabricated them instead.
The US Attorney further alleges that the practice falsely billed Medicare and TRICARE for oral appliances under billing codes applicable to expensive prosthetic devices fabricated by surgeons, rather than lower-paying billing codes applicable to appliances fabricated by an outside laboratory.
“Medical providers cannot misrepresent the services they provide in order to increase their billings to government insurance programs,” said US Attorney Matthew D. Krueger. “This settlement makes the Medicare and TRICARE programs whole and sends a message to medical providers that false billings will not be tolerated.”
“When TMJ & Orofacial Pain Treatment Centers of Wisconsin submitted claims to Medicare, it promised that it actually provided the services it billed for,” said Lamont Pugh III, special agent in charge, US Department of Health and Human Services, Office of Inspector General (OIG) Chicago Region.
“This settlement holds TMJ & Orofacial Pain Treatment Centers of Wisconsin to account for its promises. The OIG will continue to work with our federal, state, and local partners to protect vital taxpayer dollars,” said Pugh.
The government’s investigation resulted from a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. Accordingly, the whistleblower will receive a share of the settlement amount. As part of the settlement, the government and whistleblower will ask the district court to dismiss the whistleblower’s qui tam complaint.
Assistant United States Attorney Michael Carter represented the government in this matter, and the OIG and the Defense Criminal Investigative Service assisted in the investigation. The settlement agreement states allegations only. The defendants do not admit liability for the allegations.