Published: Nov. 04, 2014, 6:42 p.m.
By John O’Brien | jobrien@syracuse.com
SYRACUSE, N.Y. — The owner of a Cicero chiropractic business has agreed to pay $376,436 to the federal government to resolve allegations of overbilling Medicare over two years.
Joseph Borio, owner of Borio Chiropractic Health Center, agreed to pay the amount in a settlement with federal prosecutors, according to a news release from U.S. Attorney Richard Hartunian.
A federal investigation revealed that Borio’s business violated the federal False Claims Act by using higher billing codes than he should have and falsely certifying that the services were medically necessary, Hartunian said.
Borio submitted 10,534 claims for payment to Medicare between May 2006 and April 2008 — far more than any other chiropractor in 45 upstate and central New York counties, Hartunian said.
Borio billed for treating as many as 69 Medicare patients a day, plus non-Medicare patients in the same day, Hartunian said.
“Borio sometimes billed for personally treating hundreds of individuals in a single day,” Hartunian said. Almost all were billed at the highest reimbursement rate, the news release said. Other Central New York chiropractors used that rate only 13 percent of the time, Hartunian said.
Over those two years, Borio treated Medicare patients almost three times more frequently than other chiropractors, the news release said.
As part of his settlement with federal prosecutors, Borio admitted that he and others submitted claims to Medicare that were unsupported by his records, Hartunian said. Borio agreed to implement compliance measures as a condition of being allowed to continue participation in Medicare and other federal health care programs, Hartunian said.
“The provision of Medicare benefits must be dictated by patient need, not provider greed.” Hartunian said. “Today’s settlement demonstrates our commitment to safeguarding the Medicare Trust Fund by holding accountable those providers who inflate their bills to maximize profits.”
Borio, 49, a licensed chiropractor since 1990, said today he decided to settle with the government rather than spend 100s of thousands of dollars to continue to fight the allegations. He’d already spent a fortune over the past six years fighting the federal investigation, Borio said.
He denied defrauding Medicare. The problem was often that the government disagreed that providing maintenance therapy for his patients was medically necessary, Borio said. He admitted under the settlement that the medical notes he submitted to Medicare were not always adequate.
“But we did all the work that we billed for,” he said.
His and the other chiropractor in the office did sometimes handle hundreds of patients in a single day, Borio said. But those were unusual days, he said.
The government accused Borio of overbilling Medicare by about $120,000 over the two years, he said. The settlement amount was triple the alleged overbilling.
The case was investigated by the FBI, the U.S. Department of Health and Human Services’ Office of Inspector General, and SafeGuard Services LLC — a contractor for Medicare responsible for investigating fraud.
Contact John O’Brien at jobrien@syracuse.com or 315-470-2187.