by Ben Vernia | October 16th, 2014
On October 9, the U.S. Attorney’s Office for the Northern District of Georgia announced that a Florida-based radiology services billing company with an office in Georgia, Medical Business Services, Inc., had agreed to pay a total of $1.95 to the federal government and four states to settle civil charges, originally raised by a qui tam relator, that the company had fraudulently resubmitted claims for services after they had been denied by Medicare and Medicaid programs.
According to the U.S. Attorney’s press release:
ATLANTA – The United States Attorney’s Office announced that it has reached a settlement with Medical Business Service, Inc. (MBS), which agreed to pay $1.95 million to settle claims that it violated the False Claims Act by fraudulently changing diagnosis codes on claims to Medicare and Medicaid, in order to get the rejected claims paid on behalf of radiologists. MBS was located in Florida, with an office in Duluth, Ga.
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The civil settlement resolves the United States’ investigation into MBS’s billing practices. The United States alleges that MBS improperly coded and billed claims by radiologists that were submitted to the Medicare and Medicaid programs. Medicare and Medicaid issue guidance stating that they will not pay for certain procedures given to patients with specific diagnoses. Medicare and Medicaid will reject claims for payment that combine those procedures and diagnoses. MBS allegedly changed the diagnosis codes on previously rejected claims to avoid those restrictions in order to have the claims paid. The settlement covers a three year period, 2008-2010, during which the conduct allegedly occurred.
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The U.S. Attorney announced that the whistleblower will receive an undisclosed percentage of the federal government’s share of the recovery (which totals all but $33,000 of the settlement).
