The following is an excerpt from MedPage Today.
New York physician David DiMarco, MD, and his clinics will pay more than $2 million to resolve charges that he illegally billed Medicaid for vein treatments.
DiMarco allegedly submitted more than 1,000 claims for procedures to the government insurer without sufficient documentation to show they were actually performed or that they were medically necessary, according to the New York Attorney General.
Read NY AG's statement and the settlement agreement below.
New York – December 22
New York Attorney General Letitia James today announced that her office has reached a civil settlement with Dr. David B. DiMarco, M.D. and his companies D.B. DiMarco, M.D., P.C. (D.B. DiMarco) and DiMarco Vein Centers LLC (DiMarco Vein Centers), securing more than $2 million for Medicaid.
The settlement resolves an investigation by the Office of the Attorney General (OAG) into illegal Medicaid billing practices for vein treatments performed by Dr. DiMarco.
The OAG found that Dr. DiMarco submitted more than 1,000 claims for procedures to Medicaid without sufficient documentation to show what procedures were actually performed or why the procedures were medically necessary, resulting in overpayment of Medicaid reimbursement.
As a result of the settlement announced today, DiMarco will pay $2,139,037 to Medicaid and he will also withdraw from the New York State Medicaid program.
“When providers scam Medicaid, they take resources and medical care away from New Yorkers in need,” said Attorney General James. “My office investigated Dr. DiMarco’s illegal billing practices, and now we are returning more than $2 million in critical funding to the Medicaid program.
My office will continue to hold Medicaid providers accountable to ensure we protect the integrity of this critical program.”
Dr. DiMarco owns D.B. DiMarco and DiMarco Vein Centers, medical practices with several locations in Western New York, including Lakewood, Olean, and Ellicottville.
The OAG found that, between March 2015 and October 2021, Dr. DiMarco submitted claims to Medicaid for procedures without adequate documentation.
The OAG investigation into these claims found that Dr. DiMarco’s records did not show which procedures were actually performed, nor did they indicate why the procedures were medically necessary and thus eligible for Medicaid reimbursement.
The investigation was initiated by MFCU Lead Data Scientist Si Lok Chao, under the supervision of Director of Data Analytics Michael Wassell, and was conducted by Research Analyst Brandon Andrews and Detective Investigator Chris Canfield, under the supervision of Detective Supervisor James Zablonski and Deputy Chief Investigator William Falk.
Both the investigation and settlement were handled by Special Assistant Attorneys General Soo-young Chang of the MFCU Buffalo Regional Office and Logan J. Gowdey of the MFCU Civil Enforcement Division.
The Buffalo Regional Office is led by Buffalo Regional Director Maura O’Donnell and the Civil Enforcement Division is led by Civil Enforcement Division Chief Alee N. Scott.
MFCU is a part of the Division for Criminal Justice and is led by Director Amy Held and Assistant Deputy Attorney General Paul J. Mahoney.
The Division for Criminal Justice is overseen by Chief Deputy Attorney General José Maldonado and First Deputy Attorney General Jennifer Levy.
Reporting Medicaid Provider Fraud: MFCU defends the public by addressing Medicaid provider fraud and protecting nursing home residents from abuse and neglect. If you have information about Medicaid provider fraud or know about abuse or neglect of a nursing home resident, please file a confidential complaint online or call the MFCU hotline at (800) 771-7755. If the situation is an emergency, please call 911.
New York MFCU’s total funding for federal fiscal year (FY) 2023 is $65,717,936. Of that total, 75 percent, or $49,288,452, is awarded under a grant from the U.S. Department of Health and Human Services.
The remaining 25 percent, totaling $16,429,484 for FY 2023, is funded by New York state.
Through MFCU’s recoveries in law enforcement actions, it regularly returns more to the state than it receives in state funding.