Former Medical Director at the New Jersey Veterans Memorial Home in Paramus Agrees to Pay Nearly $700,000 to Resolve False Claims Act Allegations

the staff of the Ridgewood blog

Paramus NJ,  A doctor in Ramsey, New Jersey, has agreed to pay nearly $700,000 to resolve allegations that he and his practice violated the False Claims Act, U.S. Attorney Philip R. Sellinger announced .

Arun Sehgal and his medical practice, Preventive & Diagnostic Medical Center P.A., have agreed to pay $693,490 plus interest to resolve allegations that they violated the False Claims Act by upcoding physician services, billing for more services than they could possibly provide in one day, and billing for services that Sehgal never provided. Sehgal is the former medical director at the New Jersey Veterans Memorial Home in Paramus, New Jersey.

The settlement announced today resolves three sets of allegations from Jan. 1, 2017, to June 1, 2022:

• The defendants regularly upcoded certain Current Procedural Terminology (CPT) codes typically used to report more complex services, or services longer in duration, relating to the evaluation and management of patients. Upcoding is alleged fraudulent medical billing in which a claim is submitted for payment regarding a service that is more expensive than the service that was performed.

• The defendants knowingly submitted claims to Medicare for services that Sehgal did not provide to patients by regularly billing for impossible days. An impossible day occurs when a physician purports to provide such a high volume of services or procedures in one day that there is no way the physician reasonably could have performed them all. For example, on March 2, 2018, the time associated with CPT codes billed by the defendants for services that Sehgal provided exceeded 43 hours.

• Sehgal allegedly purported to provide services to Medicaid beneficiaries in New Jersey on days when Sehgal was not physically in the United States.

The government is represented by Assistant U.S. Attorney Robert L. Toll of the U.S. Attorney’s Office, District of New Jersey’s Opioid Abuse Prevention and Enforcement Unit, and Trial Attorney Daniel Meyler of the Department of Justice’s Civil Division Fraud Section, with assistance from HHS-OIG.

The government’s pursuit of this matter illustrates its efforts to combat healthcare fraud. One of the strongest tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services, at 800-HHS-TIPS (800-447-8477).

The claims resolved by the settlement are allegations only and there has been no determination of liability.