Med-Surg Physician Group: Q3014 Claims When Patients Were Home

Med-Surg Physician Group and its owner agreed to pay $152,383 in the Med-Surg telehealth settlement announced by the Justice Department, resolving allegations that they added Q3014 facility fees to Medicare and Medicaid claims when patients received telehealth visits at home. The code was meant to pay a facility hosting the patient. Someone who knew where those patients were could explain the discrepancy in the bills.

Med-Surg is a medical practice in Beckley, West Virginia, providing general internal medicine and medication-assisted treatment for substance use disorder. The Justice Department announced the civil False Claims Act settlement on April 2, 2025.

Q3014 Billed When the Patient Is at Home

Q3014 was the charge Med-Surg allegedly added when the patient was at home. This telehealth originating-site facility fee pays an eligible facility for resources used to connect a patient physically there with a practitioner somewhere else. The originating site is the patient’s end of the connection, and only that site may bill the fee.

A billing employee sees the added code beside the professional service, while the patient knows where the visit happened. The case connects those two views of the same claim.

West Virginia Clarified the Home Rule Before These Claims

West Virginia’s Medicaid agency issued its clarification on March 16, 2020. The claims described in the Med-Surg announcement ran from March 25, 2020 through January 27, 2021.

The Justice Department’s account identifies both the Bureau for Medical Services policy manual and the commissioner’s clarifying letter. The manual barred billing the originating-site code when the member was at home. The letter specifically said the program would not reimburse Q3014 for the member’s home.

The state had named the code and the location in writing before the alleged billing began. The government alleged that Med-Surg routinely added the facility fee despite that guidance. Taxpayers were allegedly paying for a facility’s resources when the patient was sitting at home.

Medicare’s Professional Payment Was a Separate Charge

Medicare’s pandemic payment policy addressed the practitioner’s work separately from the originating-site fee. Under its April 2020 payment rule, Medicare allowed practitioners to use the place-of-service code that would have applied to an in-person visit, with modifier 95, retaining the corresponding payment rate.

Claims Analysis Found the Pattern, Patients Supplied the Location

According to the Justice Department, investigators identified an unusual Q3014 billing pattern in Med-Surg’s Medicare and Medicaid claims, then interviewed patients. The agency said those interviews established that the practice regularly billed the facility fee for telehealth visits patients received at home.

The government said Medicare and Medicaid paid Med-Surg $76,191 on the inappropriate claims, less than the amount the practice and its owner agreed to pay to settle. The civil settlement addressed the government’s allegations about that billing and false certifications of compliance with program requirements.

The patient interviews gave the billing analysis its meaning. Each patient’s account addressed the condition the fee depended on: being physically at the originating facility. The billing system contains one account of a visit, while the people arranging or delivering care may know a different one.

The Justice Department credited the Department of Health and Human Services Office of Inspector General and West Virginia’s Medicaid Fraud Control Unit with the investigation. The case brought together the claims the programs paid and the encounters patients described.

Supportive Care Shows Why the Hosting Facility Matters

In the Supportive Care settlement, the Justice Department alleged that psychological-care providers billed Q3014 fees belonging to the nursing homes hosting their patients. The fee pays the eligible site physically hosting the patient, rather than the practitioner working elsewhere.

What an Insider Can Add to the Claims

An insider can connect the code on a claim with the encounter and the billing decisions behind it. If you handled remote visits, your knowledge of patient locations matters. If you handled billing, you can explain how the facility charge reached the claim. That connection is the value of knowledge from inside the practice.

We connect what you know about home-location facility fees to the claims and the decisions behind them. The Med-Surg investigation shows why the patient account and the billing record belong in the same conversation.

You Know Where the Patients Were

If you saw facility fees added to claims for patients you knew were at home, speak to one of our whistleblower experts about those charges. We build the case with you around the billing decisions and bring in healthcare fraud whistleblower lawyers who understand Medicare and Medicaid telehealth payments. We stay beside you to turn that inside knowledge into your strongest telehealth whistleblower case. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.