Consumer Fraud

Florida Radiology Chain Settles whistleblower Medicare Fraud Case For $8.71 Million

Pills Stethascope on Money 435x289 Florida Radiology Chain Settles whistleblower Medicare Fraud Case For $8.71 MillionTAMPA, FLA — Rose Radiology Centers Inc. will pay $8.71 million to the government to settle allegations that it violated the False Claims Act by billing federal health care programs for radiology procedures that patients didn’t need or were rendered in an “unconscionable” way that violated federal rules for reimbursement.

Rose Radiology operates about a dozen offices in the Tampa area and provides all of the radiology services for the Tampa Bay Rays baseball team and Tampa Bay Lightning hockey team, according to the Tampa Bay Times.

The settlement resolves allegations originally brought in a lawsuit filed by two whistleblowers under the qui tam provisions of the False Claims Act, which allows private parties to sue on the federal government’s behalf and share in any recovery their case brings. The whistleblowers who filed suit against Rose will share and award of $1.7 million, the U.S. Department of Justice said.

U.S. Attorney A. Lee Bentley said the agreement with Rose settles “myriad allegations involving standards of medical care, false billing practices, and breaches of trust,” adding that “there is no room for such practices in our public health care programs.”

Federal prosecutors said that Rose Radiology routinely administered injectable contrast dye into patients during MRI scans without physician supervision, as required by law because of the risk of anaphylactic shock the procedure can cause. The U.S. Department of Justice (DOJ) said that Rose knew of this safety requirement but “rarely, if ever, had a physician present when contrast dye was being administered.”

“It is unconscionable for a physician to allow someone without the proper medical training to administer a test that could cause serious harm” said Health and Human Services Special Agent Shimon Richmond. “Not only do the kinds of frauds that were alleged in this case rob Medicare of needed funds, they threatened the health of elderly and disabled Americans.”

Rose Radiology also improperly billed Medicare for radiology procedures referred by chiropractors, in violation of federal law. Medicare does not pay for diagnostic test orders made by chiropractors, but Rose accepted those orders and disguised them as bills for tests that were ordered by a Rose physician.

Rose Radiology also performed radiology procedures that were never ordered by the patients’ health care providers and then billed Medicare for the treatments when it knew that independent diagnostic testing facilities are prohibited from adding any treatments to patients without a written order from the patient’s doctor.

The DOJ also found the company engaged in the practice of giving kickbacks to physicians for their Medicare referrals to boost their Medicare-derived profits in violation of the Anti-Kickback Statute and Stark Law.

Sources:
U.S. Department of Justice
Tampa Bay Times