April 24, 2013 — Radiology Associates and Children’s Physician Services of South Texas (CPSST) have reached a settlement in a False Claims Act lawsuit filed in 2008 by an insider employee with Radiology Associates. The federal False Claims Act allows health care workers and other private individuals to file a lawsuit on the government’s behalf and then keep a share of any amounts received through the legal action. In this case, the whistleblower was a former medical coding compliance officer and revenue manager who worked for Radiology Associates. The tipster will receive between 15 and 25 percent of the settlement, in which Radiology Associates will pay $800,000 and CPSST will pay $1.5 million.
Texas Health Care Providers Alleged to Have Double Billed for Services
According to U.S. Attorney Kenneth Magidson, the case involved two Texas health care providers:
- Radiology Associates, a physician group serving, but independent from, the Driscoll Health System; and
- CPSST, which is a part of the Driscoll Health System.
Both providers are alleged to have violated the False Claims Act by double billing for the radiologists’ interpretation of genetic ultrasounds. From 2002 to 2007, CPSST allegedly submitted reimbursement claims to various federal healthcare programs for Radiology Associates’ services. After receiving payment but without disclosing receipt of the payments, CSST instructed Radiology Associates to bill the government again for the exact same services.
An ultrasound has two components — the physical taking of the ultrasound by a technician and the subsequent interpretation of the ultrasound. The agreement between CPSST and Radiology Associates was that Radiology Associates would interpret the thousands of ultrasounds taken every year at CPSST. CPSST would bill federal healthcare programs for taking the ultrasounds and Radiology Associates would bill for interpreting the ultrasounds.
But from January 2002 to June 2007, CPSST billed the government both for taking and interpreting the ultrasounds, without telling Radiology Associates. When the double billing for the interpretation component was discovered by Radiology Associates, the physician’s group confronted CPSST, which denied the practice and told Radiology Associates to keep billing for the ultrasound interpretations. Although Radiology Associates continued to find more evidence of the double billings after that time, the group just ignored it and continued to submit bills for interpreting the ultrasounds that the government had already paid once to CPSST.
False Claims Act Violations Reported by Insider Heath Care Employees
As was true in the double billing scheme reported in this Texas case, the government often learns about Medicare fraud from insider informants who are employed by health care providers involved in the scam. Before coming forward, whistleblowers need to become informed of their rights under the qui tam provisions of the False Claims Act. The experienced lawyers of Waters & Kraus provide government collaborators with the aggressive legal representation they deserve. Contact us or call our health care fraud attorneys at 800.226.9880 to learn how we can assist.