A Yonkers medical practice is demanding $1 million from its billing service for allegedly mishandling insurance claims.
Dr. Binod Shah and Spinal Pain & Rehab Medical PC accused Bays RVP Billing & Consulting of breach of contract, in a complaint filed on Aug. 28 in Westchester Supreme Court.
“If claims are not timely submitted,” the complaint states, “they are rejected and Shah and Spinal Pain do not get paid.”
Shah, of Scarsdale, founded Spinal Pain in 2005. He is a physiatrist who has held himself out as an expert in treating rotator cuff injuries, arthritis, neck pains and spinal problems.
In 2021, Shah hired Bays, of Hackensack, New Jersey, to handle billing, collections and claims appeals, according to the complaint. He authorized the company to use his National Provider Identifier, a unique number that enables doctors to bill for Medicare services and to electronically exchange information with other doctors and health plans.
Bays failed to bill in time for Covid tests, causing Spinal Pain to lose significant revenue, the complaint states, and used the NPI number to submit claims for other entities.
Claims submitted for work that Shah or Spinal Pain did not perform could expose him to liability under the federal False Claims Act, according to the complaint.
An attorney sent a cease and desist letter on March 21, demanding that Bays “immediately stop the fraudulent use of Shah’s NPI number for entities other than Spinal Pain,” the complaint states, and to turn over copies of all bills that use Shah’s NPI number.
Shah is asking the court to order Bays to defend him and to cover the costs of any actions brought under the False Claims Act or by a state licensing agency. He is also asking for a judicial order requiring Bays to provide copies of all claims submitted under his NPI number and to cease using his number for other entities.
Bays did not reply to an email asking for its side of the story.
Shah and Spinal Pain & Rehab are represented by Purchase attorney Steven J. Harfenist.
