Medsurant: Concurrent Patients and Medicare Monitoring Units

Medsurant Holdings agreed to pay $1.9 million in a Medicare concurrent monitoring settlement over allegations that it failed to account for patients it monitored at the same time for other insurers. The government described Medsurant as the country’s largest independent provider of intraoperative neuromonitoring to hospitals and surgeons.

Medsurant Holdings, based in West Conshohocken, Pennsylvania, operates as Medsurant Health. The Justice Department announced the settlement on December 30, 2019, resolving allegations under the False Claims Act.

What Intraoperative Neuromonitoring Does in the Operating Room

Intraoperative neuromonitoring follows a patient’s nervous system in real time during high-risk surgery. The services described in the government’s announcement involved the peripheral nervous system, brain and spinal cord. Medsurant provided those services to hospitals and surgeons.

The work sits alongside the operation, but it has its own billing question. Medsurant’s settlement concerned units of monitoring, while the separate concurrent-surgery case below concerned the surgeries themselves. Knowing that several operations overlapped does not tell the whole monitoring story: the allegation turns on the patients receiving the monitoring service at the same time and the units charged to Medicare.

How the Concurrent-Patient Billing Allegation Worked

The government alleged that Medsurant billed Medicare for monitoring units without accounting for concurrent services it provided to patients covered by other payers. The covered conduct ran from January 1, 2013, through May 31, 2016. For those claims, the Justice Department said Medicare required the monitoring to be provided to one patient exclusively.

The other patient’s insurance was central to the allegation. A count limited to Medicare patients would leave out people whose monitoring was happening at the same time but whose bills went elsewhere. Medicare was allegedly paying for exclusive attention while the company was also providing monitoring to other patients.

Taxpayers were being asked to pay on terms the government said the service did not meet. The distinction matters to an insider who sees the whole workload, including patients whose insurers never appear on a Medicare claim.

A 2020 paper in the Journal of Forensic and Investigative Accounting, A Forensic Accountant’s Guide to the Most Potent Federal Laws Used Against Healthcare Fraud, describes a recurring pattern in health care false claims cases: requests for more expensive care than was delivered, or for services never provided. It also distinguishes inaccurate descriptions of the service from claims that falsely represent compliance with a payment condition.

In Medsurant’s case, the government challenged whether the service met the exclusive-patient condition attached to the billed units. The question therefore reaches beyond whether a Medicare patient received monitoring: it also reaches the concurrent services provided to other-payer patients during that monitoring. The medical service and the claim have to be understood together.

Who Inside a Monitoring Company Sees the Overlap

A scheduler may know which assignments overlapped, a monitoring professional which patients were followed together, and a billing employee how the patient’s insurer affected the units counted. Those perspectives can reach across the divide between the clinical work and the claim for payment. Our whistleblower experts work with you to understand those decisions and build a case around what you know about the business.

Separate monitoring allegations concerned interpreting qualifications at Marshfield Medical, formerly Bromedicon, referral payments at Assure, and unnecessary higher-level mobile cardiac outpatient telemetry at CardioNet. The concurrent-surgery allegations against Neurosurgical Associates and Dignity Health’s St. Joseph’s Hospital concerned the surgeries billed, while Medsurant’s concerned monitoring units and patients covered by other payers.

Medicare Fraud Whistleblower Rewards

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. If your knowledge connects monitoring assignments to false Medicare claims, our whistleblower experts can assess that connection with you and develop the case around the billing decisions you understand.

You Know Who Was Being Monitored

If you saw patients disappear from the count used to bill Medicare, speak to one of our whistleblower experts about the monitoring and the claims. We build your strongest Medicare whistleblower case with you, bring in healthcare whistleblower lawyers who understand Medicare service billing, and stay beside you as the case moves forward.