THD America and its corporate parent, THD SpA of Italy, recently agreed to pay $700,000 to resolve allegations from the US Attorney’s Office, District of Maryland, that the company violated the False Claims Act by “knowingly causing physicians to use incorrect codes to obtain inflated reimbursement from Medicare and state Medicaid programs,” for the use of its Slide One Kit hemorrhoid removal system, according to the Department of Justice (DOJ).
The system was sold to healthcare providers for use in transanal hemorrhoid dearterialization — a surgical procedure that involves cauterizing certain blood vessels — and was required to be billed using a temporary code, also known as a T-Code, which is assigned to new and emerging services. However, as the procedure is considered experimental, reimbursement for its use was often denied by insurance.
In order to circumvent denials and increase potential reimbursement, the US alleged that, between 2014 and 2017, THD encouraged colorectal and general surgeons to improperly bill Medicare and Medicaid programs using the T-Code plus an additional CPT code, or bill for CPT codes other than the appropriate T-Code.
“This case is emblematic of the United States Attorney’s Office’s commitment to pursuing and holding accountable those who seek to defraud federal health care programs and to recouping taxpayer dollars obtained falsely,” said Erek L. Barron, United States attorney for the District of Maryland, in the press release announcing...
On January 15, the U.S. Department of Justice (DOJ) released Fiscal Year 2024 statistics for the False Claims Act. During FY 2024, settlements and judgments under the False Claims Act exceeded $2....