Feel Well Health Center: Office Claims for Remote Services

Feel Well Health Center and its physician owner agreed to pay $2,656,686 in the Feel Well telehealth settlement, which covered office-service claims and several other billing and kickback allegations. The governments alleged that claims placed the physician in an office suite while he was abroad, on vacation or working elsewhere.

The Justice Department announced the civil settlement on November 10, 2022. It identified the practice as Feel Well Health Center of Southington, P.C., then doing business as Confidia Health Institute, with primary care offices in Southington and Bristol, Connecticut. Its physician owner also operated a practice in Indialantic, Florida until mid-2019.

The federal and state governments alleged improper billing of Medicare, Connecticut Medicaid and the State of Connecticut Comptroller Healthcare Programs. The settlement covered office and telemedicine claims, fitness services billed as medical visits, unnecessary testing and payments tied to laboratory orders.

What the Office Claims Represented

From April 2016 through March 2020, the governments alleged, Feel Well and its owner billed for services supposedly rendered by the physician in an office setting when he was not physically present in the office suite. The government’s account separately says that claims submitted as telemedicine failed applicable office-location requirements or did not use an interactive telecommunications system.

An office schedule and a medical claim describe the same working day from different directions. The schedule can place a practitioner in another office. The claim can put that practitioner in the office suite.

Telephone care, video visits and other remote services have distinct payment rules. We connect the service actually delivered to the particular claim, payer and requirements that applied when it was billed.

Gym Visits, Unnecessary Tests and Laboratory Kickbacks

The settlement also resolved allegations about what patients received and why laboratory services were ordered. They included fitness services billed as medical care and payments tied to laboratory orders.

Gym Visits Became Medical Visits on Paper

Between April 2016 and January 2020, the governments alleged, patients received fitness services at a gym operated by Feel Well and its owner, staffed by a medically unlicensed coach and yoga instructor. The practice allegedly billed those visits as medical care even though they had no legitimate medical component.

A fitness visit allegedly acquired a false diagnosis and a false medical record so a health care program would pay for it. Someone who worked with the patients could know what happened at the gym. Someone in billing could see the medical service presented for payment.

Tests the Government Said Were Unnecessary

The testing allegations ran from April 2016 through August 2021. They concerned medically unnecessary neurofeedback, ultrasounds and autonomic function testing.

What Does Kickback Mean in Healthcare?

A kickback buys a referral or an order. Here, the governments alleged that Feel Well and its owner received payments from Boston Heart Diagnostics Corp. in return for ordering laboratory services for Medicare patients.

The laboratory-payment allegations concerned purported processing and handling fees from October 2012 through June 2014, followed by speaker fees from January 2017 through December 2018. The government described the speaker fees as exceeding fair market value.

Medicare Claims Data Started the Investigation

The Department of Health and Human Services Office of Inspector General investigated Feel Well. The Justice Department said the allegations arose from an investigation based on analysis of Medicare claims data.

A claim records what the payer was asked to accept. Office schedules, medical records and communications records can help explain how that account compares with the work actually done.

What Evidence Is Needed to Prove Fraud?

For an office-service claim, useful evidence connects who treated the patient, where the physician was, how the encounter took place and what the payer was billed. We work with insiders to connect those facts to the service represented on the claim.

The Same Billing Question in Other Telehealth Cases

Other civil telehealth cases show how the service, location and billing party can each become the disputed part of a claim. In the CPC Associates settlement announced in 2016, the government alleged improper Medicare billing for psychiatric services delivered by telephone from January 2009 through June 2015. Its account identified patients outside qualifying rural areas and the absence of the interactive audio-and-video system required for those claims.

Supportive Care allegedly billed facility fees that belonged to the nursing homes providing administrative and clinical support. Med-Surg Physician Group allegedly added originating-site facility fees to telehealth claims while patients were at home.

Feel Well’s Billing Integrity Agreement

Feel Well and its owner also entered a three-year billing Integrity Agreement with the Department of Health and Human Services, designed to ensure future compliance with federal healthcare program requirements. The settlement addressed allegations about office and telemedicine claims, fitness services billed as medical visits, unnecessary testing and payments tied to laboratory orders.

Can a Telehealth Whistleblower Receive a Reward?

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. We build the case around your knowledge of how the practice’s services became claims.

You Know Where the Physician Was

If you know how a remote encounter became an office claim, talk with our whistleblower experts about the billing you saw. We build the case around your knowledge of the practice and bring in telehealth fraud whistleblower lawyers who understand the service, the payer and the claim. We stay with you as partners through the case, connecting what happened in the practice to what the government paid for.