Metro Atlanta Arthritis Specialist Settles Medicare Fraud Case for $2.18 Million

A prominent metro Atlanta rheumatology practice has agreed to pay $2.18 million to resolve allegations that it submitted false claims to Medicare, federal prosecutors announced Wednesday.

The settlement stems from a years-long investigation into Medical Specialists of North Georgia (MSNG), a practice specializing in arthritis treatment and management. Federal authorities alleged that between 2018 and 2022, the practice billed Medicare for services that either weren’t medically necessary or weren’t properly documented according to federal healthcare regulations.

According to the U.S. Attorney’s Office for the Northern District of Georgia, the practice repeatedly billed Medicare for high-level evaluation and management services that didn’t meet the complexity requirements for such claims. Investigators also found instances where documentation failed to support the level of service claimed in the billing submissions.

“Healthcare providers who submit false claims to Medicare not only drain critical resources from the program but also undermine the integrity of our healthcare system,” said U.S. Attorney Ryan K. Buchanan in a statement. “This settlement demonstrates our commitment to protecting taxpayer dollars and ensuring that Medicare funds are used properly for necessary medical care.”

The case highlights the federal government’s ongoing efforts to combat healthcare fraud, particularly in Medicare, which provides health insurance to approximately 65 million Americans aged 65 and older and younger people with certain disabilities. Medicare fraud costs taxpayers billions of dollars annually and has been a priority enforcement area for the Department of Justice.

The investigation was conducted as part of a collaborative effort between the U.S. Attorney’s Office, the Department of Health and Human Services Office of Inspector General, and the FBI’s Healthcare Fraud Unit. The settlement was reached without a determination of liability, meaning that while MSNG agreed to the payment, it did not admit wrongdoing as part of the agreement.

MSNG, which operates multiple clinics throughout metro Atlanta, has built a reputation as one of the region’s largest rheumatology practices. The specialty focuses on diagnosing and treating arthritis, autoimmune diseases, and other inflammatory conditions affecting joints and connective tissues—conditions that disproportionately affect the elderly, who make up a significant portion of Medicare beneficiaries.

Healthcare billing experts note that rheumatology practices face particular scrutiny from Medicare auditors due to the chronic nature of conditions they treat and the complexity of care involved.

“Rheumatologists often manage patients with multiple chronic conditions requiring extensive documentation and complex decision-making,” said Janet Morgan, a healthcare compliance consultant not involved in the case. “But Medicare has specific requirements for what constitutes a high-level visit, and practices must ensure their documentation supports the billing codes used.”

The settlement also requires MSNG to enter into a corporate integrity agreement with the Department of Health and Human Services. Such agreements typically mandate enhanced compliance programs, regular audits, and reporting requirements for a period of three to five years.

This case comes amid increased federal scrutiny of medical billing practices nationwide. In fiscal year 2022 alone, the Justice Department recovered more than $1.7 billion from healthcare fraud settlements and judgments, with a significant portion involving improper Medicare billing.

Patients of the practice will not be affected by the settlement, and MSNG will continue to provide rheumatology services throughout the metro Atlanta area. The practice has reportedly implemented additional training and compliance measures for its physicians and billing staff to prevent similar issues in the future.

Medicare beneficiaries are encouraged to review their Medicare Summary Notices regularly and report any suspicious charges to the HHS Office of Inspector General hotline.

For patients concerned about potential billing issues, healthcare advocates recommend maintaining personal records of all medical visits and requesting itemized statements to better understand the services for which they’re being billed.