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May 25, 2023

Waterbury health business pays $400K false claims settlement

Contributed Attorney General William Tong.
By Michelle Tuccitto Sullo

Waterbury-based healthcare business has paid nearly $400,000 to resolve allegations of false claims and improper billing.

Corebella Health LLC and its owner, Marcos De Escobar, entered into a civil settlement agreement with both the federal and state governments, officials announced Wednesday. 

The business allegedly submitted false claims to the Medicare and Medicaid programs, and received overpayments from both. As part of the settlement, the business paid 

$399,440, according to the U.S. Attorney’s office and state Attorney General’s office.

Attorney General William Tong said the business allegedly “systematically overbilled.”

The improper billing happened over a three-year period, between Jan. 1, 2016 and Dec. 31, 2018, according to the government.

“Abuse of taxpayer dollars is never acceptable, and we will not hesitate to use the full weight of our authority to protect our public healthcare programs,” Tong said in an announcement. 

Corebella provides medical and wellness services. According to the business’ website, it provides services related to allergies, weight loss and hormonal imbalances.

The business allegedly improperly billed for allergy immunotherapy preparation and office visits, also known as evaluation and management (E&M) services. 

According to the government, the business submitted claims to Medicare and Medicaid for services rendered by physicians, when the services had actually been provided by nurse practitioners. 

Medicare and Medicaid reimburse for nurse practitioner services at a lower rate than for care provided by a physician. Medical providers may sometimes seek the higher rate, such as if there had been physician supervision of the nurse practitioner care, but that was not the case, according to the government.

The business also allegedly submitted claims for more allergy immunotherapy units than it actually prepared for patients, resulting in overpayments from Medicare and Medicaid.

Medicare and Medicaid consider evaluation and management services on the same day as a procedure to be part of the work of the procedure, and do not allow a separate payment for the office visit. If a significant, separate service is provided on the same date, the provider can use a “Modifier 25” to bill for both the procedure and for evaluation and management services.

However, the business improperly added this modifier to claims when providing allergy injections when no significant separate services had been provided, according to the government. 

The business' attorney in the matter, Jody Erdfarb of Wiggin & Dana, could not immediately be reached for comment.

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