Union Foot Solutions: Billing Around an Exclusion
The Union Foot Solutions settlement required its former owner to pay $42,000 to resolve allegations that he caused false Medicare claims by billing around his exclusion from federal health care programs. The business obtained Medicare authorization after he transferred his ownership interest, but he kept treating patients. The government alleged that his work and orders then reached Medicare under another pedorthist’s name. The alleged claims asked Medicare to pay for work by someone it had already excluded. For someone inside a medical supply company, the question is familiar and concrete: whose work does the billing actually represent?
Union Foot Solutions, LLC operated as Union Orthotics and Pedorthics, a medical supply company in Schenectady, New York. The Justice Department’s March 13, 2023 announcement concerned the company’s former owner, a former Niskayuna surgeon.
Medicare Enrollment Began With False Answers
The former owner admitted in the settlement agreement that Union Foot Solutions’ Medicare application falsely denied both his license history and his exclusion from federal healthcare programs. Those answers concerned the very restrictions that stood between the business and Medicare payment.
In early 2000, the New York State Board of Professional Medical Conduct revoked his medical license. Later that year, the Office of Inspector General for the Department of Health and Human Services excluded him from all federal health care programs, including Medicare. The Justice Department explains the effect plainly: federal programs could not pay for items or services he furnished, directed or prescribed.
He subsequently opened Union Foot Solutions and applied for the company to participate in Medicare. The application represented that he had never had a healthcare license revoked or suspended and had never faced suspension or exclusion from federal health care programs.
The Centers for Medicare & Medicaid Services denied the application because his exclusion prevented the company from receiving Medicare payment. The application had already put the operator’s eligibility directly in front of the agency, and the agency had said no.
An Excluded DME Owner Transferred Ownership and Kept Working
The excluded DME owner transferred his ownership interest in Union Foot Solutions to a third party. The new owner reapplied and obtained Medicare authorization. In the same account of his settlement admissions, the former owner acknowledged that he continued working for the company and rendered orthotic and prosthetic care to patients.
The person providing care remained inside the business after someone else became its owner. That continued work is what connects the denied application to the later billing allegations.
The industry’s Medicare supplier standards treat enrollment as more than a company name. Suppliers certify compliance with licensing requirements, may not contract with an excluded entity to fill orders, and may not convey or reassign a supplier number. The supplier’s ability to bill and the eligibility of the people or businesses behind its orders are both part of the payment system.
The allegation concerns what happened after that approval: the excluded former owner continued providing care, and the government said his involvement disappeared from the name used for billing. An ownership record can show who took over the company. Patient-care and ordering records can show who remained at work.
Medicare Claims in Another Pedorthist’s Name
The United States alleged that, from December 1, 2016 through February 28, 2018, the former owner caused Union Foot Solutions to submit false Medicare claims for services he furnished and ordered for beneficiaries. It further alleged that he caused the company to bill his services and the items he ordered in another pedorthist’s name to conceal his involvement and get around the exclusion.
The company had Medicare authorization, and the claim carried another practitioner’s name. The government’s allegation reached behind both to the excluded person who actually supplied the care or ordered the item.
For an employee, the useful knowledge may be very ordinary: who saw the patient, who ordered the device, and whose name appeared when the company billed Medicare. In this case, the government alleged that the billing name concealed the person responsible for the work. The distinction between the person treating a patient and the person named for billing can be visible inside a business long before it is visible outside it.
What an Insider Can Bring to an Exclusion Case
The enrollment application, the denial, the ownership transfer and the claims describe different decisions inside Union Foot Solutions. Someone who handled enrollment may know what the company disclosed about its operator. Someone who worked with patients may know who continued providing care. A billing employee may know whose name the company used for those services and orders.
Our whistleblower experts work with you to connect those parts of the business. Your account of what happened inside the supplier can make that connection clearer than an ownership document alone.
A whistleblower case under the False Claims Act can pay the whistleblower 15% to 30% of what the government recovers.
You Know Who Kept Doing the Work
If a supplier changed owners while an excluded operator kept treating patients or ordering equipment, talk with our whistleblower experts about what you saw. We build the case with you around the work, the enrollment history and the billing, and bring in durable medical equipment whistleblower lawyers who understand exclusion cases. We stay with you from the first conversation to building your strongest Medicare whistleblower case.
