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Arun Sehgal and his Ramsey practice, Preventive & Diagnostic Medical Center P.A., violated the "False Claims Act" by billing patients for more service than they could possibly provide in a single day, or for services that they never provided, U.S. Attorney Philip R. Sellinger said Thursday, Feb. 22.
Sehgal and his practice agreed to pay $693,490 plus interest to resolve the three allegations laid out by Sellinger:
1. Sehgal and his practice "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.
2. 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 happens when a physician alleges 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."
In Sehgal's case, this happened on March 2, 2018, the time associated with CPT codes billed by the defendants for services that Sehgal provided exceeded 43 hours for that day, Sellinger said.
3. Sehgal said to provided services to Medicaid beneficiaries in New Jersey on days when he was not physically in the United States, according to Sellinger.
Sehgal's bio on his office's website says he specializes n adult medical care, maintaining a "close doctor-patient relationship. He believes in interacting directly with his patients and communicates effectively to provide them with an exemplary level of care, with a goal of optimizing health and well-being."
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.
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