Newswise — Two years ago, AANEM Member, Peter A. Grant, MD, was contacted by the FBI. He was asked to review 35 patient charts in a case involving Dr. Harcharan Narang, who owned and operated North Cypress Clinical Associates, and Dr. Gurnaib Sidhu and Dayakar Moparty, who managed and operated the now defunct Red Oak Hospital in Houston, Texas.
“In reviewing these charts, it became readily apparent that EDX fraud was being committed. I conducted a rather exhaustive and analytical review and then authored a 27-page report which detailed all the inadequacies, inaccuracies and fraudulent tactics I identified,” said Dr. Grant.
Dr. Grant says this case was unique in that patients were being lured to the perpetrators’ clinic with a Groupon for weight loss.
“Once there, they were scheduled for a battery of medical tests including extensive electrodiagnostic (EDX) studies,” explained Dr. Grant. “I found that more than 85% of the EDX studies had serious problems rendering the results unreliable and inaccurate. Additionally, since the perpetrators had formed a ‘hospital,’ they were able to bill extremely high charges for the EDX studies. As crazy as it seems, the studies were often more than $30,000 for a one-extremity EMG (which was not even performed) and nerve conduction study exams. In fact, CPT code 95912 alone (11-12 nerves) was billed at $19,773!”
In February 2019, Narang and Moparty’s case went to trial and Dr. Grant provided expert witness testimony. The trial lasted for 2 weeks and the jury deliberated for less than 4 hours before convicting Narang and Moparty (Sidhu, the co-conspirator, had previously pleaded to conspiracy to commit health care fraud and is awaiting sentencing).
As stated in a press release from the United States Attorney’s Office in the Southern District of Texas, Narang and Moparty face up 10 years in federal prison for each count of health care fraud and up to 20 years for each count of money laundering. Their sentencing hearing is set for June 20, 2019.
“Unfortunately, EDX fraud is rampant,” noted Dr. Grant. “The CPT coding changes with associated reimbursement cuts of January 2013 did not help in deterring EDX fraud as intended. In fact, mobile diagnostic EDX labs (and other types of EDX fraud) are escalating in this environment. What I see in my EDX fraud work is truly the ‘tip of the iceberg’ as it is much more pervasive than most would think.”
Dr. Grant says that “EDX fraud not only wastes healthcare dollars, but the quality of patient care suffers greatly. These inappropriate and inaccurate studies did not help patients in finding appropriate treatments or solutions to their medical problems, but, in fact, often sent them down costly and ineffective paths of treatment. All too often, patients have inappropriate treatments (including surgeries) and/or do not have the appropriate treatments ordered as a result of these fraudulent EDX studies.”
If you encounter an EDX fraud and abuse in your practice, Dr. Grant says that reporting is it “important and necessary.”
“We all have a role in policing our specialty and protecting our patients. Ways to address this might include reporting it to the fraud and abuse department of the insurance company billed, reporting it to a local US attorney’s office, or calling the AANEM.”
Shirlyn Adkins, JD, AANEM Executive Director, says the high cost of healthcare is an important topic on many peoples' minds and how we solve this problem has been a struggle.
“A great first step is for Congress and private carriers to stop the fraud and abuse in our healthcare system,” said Adkins. “We are very grateful that Dr. Grant took the time to help the FBI fight this case. He has been tirelessly fighting to help stop EDX fraud and abuse for years, not only as an expert witness but also working with AANEM as an Advocacy Advisor and meeting with both Medicare and Congress to try and create some commonsense solutions to stop these bad actors. We also hope that both Medicare and Congress see this case and realize the magnitude of this ongoing problem and work with AANEM to end EDX fraud.”