Edgewater Chiropractor: A Share of Clinic Collections and Alleged Kickbacks
In the Edgewater chiropractor knee-brace settlement, a former clinic owner agreed to pay $2 million to resolve allegations of unnecessary knee injections, custom knee braces and manufacturer kickbacks. The Justice Department said he helped promote the Osteo Relief clinic model to other chiropractors and received a percentage of the clinics’ collections. The government alleged that he helped drive unnecessary care across those clinics while also receiving benefits for ordering more braces at his own.
The Justice Department announced the False Claims Act settlement on April 6, 2020. The chiropractor had previously owned and managed a clinic in Edgewater, New Jersey. For someone inside a clinic or brace business, the case connects decisions that can look separate on paper: promoting a treatment model, sharing its collections, choosing equipment and allegedly accepting manufacturer benefits.
The Osteo Relief Clinic Model
The Osteo Relief business model combined osteoarthritis treatment with knee braces. According to the Justice Department’s account, the former clinic owner and a business partner promoted the model to other chiropractors, including how to run and market a clinic specializing in fluoroscopic-guided viscosupplementation injections and knee braces. That effort led to the formation of the Osteo Relief Institutes.
Viscosupplementation involves injecting a gel-like fluid into the knee joint to lubricate it and supplement the properties of the joint’s natural fluid. The clinics offered both that procedure and knee braces to patients with osteoarthritis.
The Justice Department said the chiropractor received a share of the Osteo Relief clinics’ collections through his association with the business partner.
What the Government Alleged About Injections and Braces
The government alleged that the chiropractor caused his own clinic and other Osteo Relief clinics to bill Medicare for injections that patients did not need and to provide unnecessary custom knee braces. Patients received care they did not need, according to the allegations, and Medicare and taxpayers bore the cost.
The injection allegations went further than unnecessary treatment. The Justice Department said the clinics used multiple brands of viscosupplements successively on patients without clinical support. It also alleged the use of discounted viscosupplements reimported from foreign countries.
The alleged manufacturer arrangement added another financial incentive. The government said the chiropractor solicited and received kickbacks from a knee-brace manufacturer in exchange for ordering more of its braces for his clinic. The purchasing records show the manufacturer benefits behind an order; the patient chart records the care.
Medicare Claims Data Led to the Investigation
The Justice Department said the allegations in the Edgewater settlement were identified through a government investigation arising from critical analysis of Medicare claims data. The investigating agencies included the U.S. Attorney’s Office for the District of Minnesota and the Department of Health and Human Services Office of Inspector General.
An earlier settlement with seven former Osteo Relief Institutes and their owners, announced on October 18, 2019, called for more than $7.1 million collectively. That clinic settlement also resolved a whistleblower’s qui tam lawsuit against the clinics and their owners. The former Edgewater owner’s settlement followed separately the next spring.
The government reached both the clinics and someone who helped promote their model. An employee’s knowledge of the collections arrangement or the manufacturer’s offer explains the business decisions behind the billed care.
What Custom Knee Braces Require From the Clinic
A custom knee brace is made for one patient by someone trained to fabricate it. The Medicare payment law describes making the brace over a model of that patient. An off-the-shelf brace needs only minor adjustments the wearer can make, without specialist fitting.
That distinction makes the information exchanged between clinic and manufacturer consequential. Patient images, fabrication instructions and communications about fit connect the order to the person who will wear the brace.
In a separate complaint about Vision Quest Industries, a knee-brace maker, and the Osteo Relief clinics, the government alleged that restrictions on direct communication prevented the company from correcting poor-quality patient photographs used to make custom braces.
What Is the Reward for a Medicare Fraud Whistleblower?
A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.
For a clinic employee, purchasing specialist or manufacturer employee, the useful knowledge sits at a particular point in the business: the treatment decisions, the brace orders, the payments or the instructions passed between companies. Our whistleblower experts work with you to connect what you know to the Medicare claims and the people making those decisions.
You Know How the Clinic Made Its Money
If you saw brace orders grow around manufacturer benefits or a treatment model built to increase collections, speak to one of our Whistleblower Experts about how the clinic made its money. We bring in healthcare fraud whistleblower lawyers who know knee-brace cases, build your strongest Medicare whistleblower case around what you know, and stay beside you through the whole journey.
