Salisbury medical practice to pay over $286k for healthcare, wire fraud

SALISBURY, Md. – A Salisbury medical practice is paying the United States over $286,000 to resolve claims that the practice bills for medical services that were not provided.

The settlement agreement was announced on Friday, involving Peninsula Internal Medicine, LLC, and the estate of former owner Candy Burns.

On June 25, 2019, Candy Burns was indicted by the U.S. on one count of healthcare fraud and nine counts of wire fraud. In early December 2019, Burns reportedly suffered a brain aneurysm and persisted in a vegetative state. The U.S. dismissed the indictment against Burns in April 2020, and Burns died in January 2021.

According to the settlement agreement, from January 1, 2009, to June 30, 2016, Peninsula Internal Medicine and Burns billed and were paid for blood draws that were not rendered. The blood draws were performed by LabCorp in the office’s Winterplace Parkway location, and LabCorp was paid for these blood draws. In addition, PIM and Burns were paid by Medicare for smoking cessation counseling that was not performed. The settlement agreement also resolves claims that PIM and Burns violated Medicare’s “incident to” rules by billing for services provided by a mid-level provider on Fridays when no physician supervised or directed medical services. We’re told Medicare reimburses at a higher rate if the services provided by a mid-level provider is performed “incident to” the direction and supervision of a physician. The only physician employed by Peninsula Internal Medicine did not work on Fridays. Burns and PIM billed Medicare for services on Fridays as if they were supervised by a physician, falsely entitling them to greater reimbursement.

This settlement resolves a lawsuit filed by a former employee of Peninsula Internal Medicine, Kimberly Elliott, under the whistleblower provision of the False Claims Act. As part of this settlement, Elliott will receive a total of $57,326.26.

Officials added that the claims resolved by this settlement are allegations only, and there has been no determination of liability.