PORTLAND — The U.S. Department of Health and Human Services filed a complaint in federal court against Lincolnville skin care center Maine Dermatology LLC, citing false Medicare claims made over a three-year period. DHHS, through the U.S. Attorney’s Office in Portland, said the Lincolnville skin doctors submitted $314,908 worth of false claims to Medicare from June 1, 2010 through Aug. 9, 2013.

Because the federal False Claims Act allows at least double damages, the U.S. attorney is asking for $629,816 in compensation. The complaint, filed in U.S. First District Court in Portland, outlines a settlement with the dermatologists.

“Based on the United States’ investigation, Defendant Maine Dermatology acted with knowledge or reckless disregard of clear guidance from the Medicare Program that its Medicare claims at issue were ineligible for payment,” wrote U.S. Assistant Attorney John G. Osborn.

Maine Dermatology LLC operates a skin care center at 2239 Atlantic Highway (Route 1), Lincolnville.

Through its attorney, Lawrence Vernaglia, of the Boston-based Foley & Lardner, Maine Dermatology LLC issued the following statement Oct. 28:

“Maine Dermatology, LLC Announces Settlement

Medicare is a federal insurance program that provides health insurance to approximately 50 million Americans, most of them elderly or disabled, wrote Osborn.

“Under Medicare, any services billed must be medically necessary, and any provider billing Medicare must have documentation showing the medical necessity of those services,” he wrote. “Under Medicare, a participating provider can bill the program for evaluation and management services (“E&M services,” also known as office visits) provided to a patient on the same day as a separate procedure or procedures only if the provider can show that the E&M service for which it seeks payment is a significant, separately identifiable service from the other procedures provided.

“Providers must use Modifier 25 in order to receive reimbursement for providing E&M services to a patient on the same day as a separate procedure. When using Modifier 25, Medicare requires the provider to produce documentation, on request, demonstrating that the E&M service was a significant, separately identifiable service from the other services provided.

“Medicare regulations also require that providers accurately bill for the services that they provide. On claims submitted to Medicare, providers use Current Procedural Terminology (“CPT”) codes to describe the services that were provided to a beneficiary. The CPT codes for established patient office visits range from 99211 to 99215. The complexity of the office visit and/or the length of time spent with the patient determines the correct CPT code to use, with 99211 representing the shortest/simplest office visit and 99215 representing the lengthiest/most complex office visit.

“Medicare reimbursement increases as the length and complexity of the visit increases.”

For three years, DHHS maintains that the Lincolnville dermatologists, “in a significant number of instances... billed Medicare for providing E&M services to individual patients on the same day that it had also billed for medical procedures, despite the fact that each E&M service was not a significant, separately identifiable service from the procedures provided.”

An investigation by the Office of Inspector General maintains that the dermatologists billed Medicare for lengthier and/or more complex services than it had actually provided.

Reach Editorial Director Lynda Clancy at lyndaclancy@penbaypilot.com; 207-706-6657