Jersey Pain Clinic Admits to Health Care Fraud, Agrees to Over $380K in Penalties

Pain Specialists, P.A., with offices in Atlantic, Cape May, and Cumberland counties, overbilled insurers by misusing a physician’s credentials during his absence.

A New Jersey-based pain management clinic has admitted to committing health care fraud and will pay more than $380,000 in criminal and civil penalties after overbilling Medicare, Medicaid, and private insurers, federal prosecutors announced Thursday.

Pain Specialists, P.A., which operates clinics in Northfield (Atlantic County), Vineland (Cumberland County), and Cape May Courthouse (Cape May County), pleaded guilty before U.S. District Judge Karen M. Williams to one count of health care fraud. The clinic also entered into a civil settlement with the United States to resolve additional allegations of fraudulent billing under the False Claims Act.

According to court documents and information presented in court, from November 2015 through January 2020, Pain Specialists used the National Provider Identifier (NPI) of its owner, a physician specializing in anesthesia and pain management referred to as “Individual-1,” to bill for services that required either his direct involvement or supervision. However, during these times, Individual-1 was not physically present—often traveling and out of the office. The clinic collected approximately $58,365.26 in reimbursements for these services.

Further, the civil settlement addresses allegations that from January 2014 to November 2020, Pain Specialists billed Medicare and Medicaid improperly by listing a physician as the rendering provider for services that were actually delivered by non-physician practitioners, without a physician present. This violated Medicare’s “incident-to” billing rules and Medicaid’s requirements for proper provider identification.

As part of its resolution, Pain Specialists agreed to pay $58,365.26 in criminal restitution, an $81,711.36 criminal fine, and $240,000 to settle civil claims. The civil settlement resolves allegations only; there has been no formal determination of civil liability.

The investigation was conducted by agents from the U.S. Department of Health and Human Services, Office of Inspector General; the FBI’s Atlantic City Resident Agency and Healthcare Fraud Task Force; and the U.S. Drug Enforcement Administration’s New Jersey Division.

The case is being prosecuted by Assistant U.S. Attorneys Daniel A. Friedman and Susan Pappy, and Trial Attorney Daniel Meyler of the Department of Justice’s Civil Division.