A major settlement was announced by U.S. Attorney Jacqueline C. Romero today, in which Florida-based durable medical equipment supplier Electrostim Medical Services, Inc. (EMSI) and its Founder and Chairman Mario Garcia, Jr. agreed to pay $20 million to resolve allegations that they violated the False Claims Act. This resolution was due to EMSI and Garcia's billing of federal healthcare programs for excessive and unnecessary TENS (Transcutaneous Electrical Nerve Stimulation) supplies. The settlement, it should be noted, is contingent on their claimed limited ability to pay.
According to the U.S. Attorney's Office, Eastern District of Pennsylvania, EMSI engaged in a billing scheme between 2018 and 2019 that saw them targeting beneficiaries of federal healthcare programs, particularly TRICARE, which reimburses unbundled supply codes. The company was accused of including improperly billing for supplies from the outset, and of submitting claims for monthly resupply of traditional electrodes for patients who were simultaneously receiving a medically unnecessary garment with integrated electrodes.
As part of a multi-agency investigation that spanned several years, officials delved into the alleged billing practices of EMSI. U.S. Attorney Jacqueline C. Romero underscored the importance of ethical conduct among medical suppliers, especially for the sake of service members and their families. "EMSI and Garcia served their own financial interests over and above the medical needs of patients. This conduct will not be tolerated by my office. We will work tirelessly to hold businesses like this to account," she stated in the release.
Brian J. Solecki, Acting Special Agent in Charge with the Defense Criminal Investigative Service (DCIS) Northeast Field Office, expressed a similar sentiment, highlighting the importance of protecting TRICARE's integrity. "Medically unnecessary services and fraudulent expenses place a tremendous burden on the TRICARE program. We will continue to work with the U.S. Attorney’s Office and our law enforcement partners to ensure that individuals who engage in fraudulent activity, at the expense of the U.S. military, are held accountable for their actions," he told the U.S. Attorney's Office.
This settlement reportedly concludes a thorough investigation by agencies including DCIS, the Office of Personnel Management Inspector General (OPM-OIG), the United States Postal Service Inspector General (USPS-OIG), and the Department of Veterans Affairs Inspector General (VA-OIG), among others. Assistant United States Attorneys Charlene Keller Fullmer, Bryan C. Hughes, and former Assistant United States Attorney John T. Crutchlow managed the civil investigation and settlement process, supported by Auditor George Niedzwicki. It is crucial to recognize, as stated in the announcement, that the government's case comprises allegations, and no determination of liability has been made.
