Brian Stimson Quoted in Part B News Article Discussing Modifier 25 Misuse

AGG Litigation and Healthcare partner Brian Stimson was quoted in an October 2, 2023, Part B News article discussing an $850,000 DOJ settlement over alleged misuse of modifier 25 by an oncology practice in Maryland.

Brian provided insight into the government’s investigation that led to the allegations. He also shared advice for practice managers to remain in compliance and avoid a False Claims Act (“FCA”) case.

As FCA claims should be based on the “subjective intent” of defendants, “not whether the defendants’ beliefs were objectively reasonable,” Brian noted the importance of interpreting the modifier ahead of time and on record.

Evidence before the fact that you believe your interpretation of modifier 25 is correct “can be a defense in the future against a False Claims Act case,” he said. “It shows you’re not acting recklessly.”

Brian also said this evidence “could come in the form of advice from counsel on how to comply with FCA when applying modifier 25, or an internal memo that acknowledges that their practices related to 25 are based on advice of counsel.”

To read the full article, subscribers to Part B News may click here.