Dear AuntMinnie Member,
A radiology group in Florida has paid $2.5 million to the U.S. government to settle allegations of Medicare fraud. The charges centered on allegations that the group had improperly coded medical imaging exams in claims submitted to Medicare.
The U.S. Department of Justice launched an investigation of the Fort Myers-based group after a former coding supervisor filed a whistleblower lawsuit that charged that Medicare was paying the group some $750,000 per month in false claims, starting in 1994. The government cited several examples of inappropriate billing that it claimed occurred at the group, such as billing for exams not ordered by the patient's treating physician.
The practice admitted no wrongdoing in settling the case, and a representative said the group has implemented new procedures to boost its documentation, such as documenting verbal orders for tests from referring physicians.
Does the case represent a more vigilant posture on the part of the U.S. government in monitoring Medicare claims -- a development that could have ominous implications for U.S. imaging practices? Or is it simply an isolated case based on one group's experience?
One thing is for sure -- the case indicates that whistleblowers can be rewarded handsomely for turning on their employers. The former coding supervisor in the Florida case is receiving nearly $450,000 as her share of the settlement under federal whistleblower laws. That's something to keep in mind the next time it's office goodie day.
Read all about the story in our Imaging Center Digital Community, at centers.auntminnie.com.
