Government intervenes in whistleblower’s suit alleging radiology fraud

by Ben Vernia | June 4th, 2020

On May 19, the Department of Justice announced that it was intervening in a False Claims Act suit filed by a whistleblower in California. The Government alleges that the defendants, a radiologist and his practices, submitted false claims for reimbursement to federal health care programs. According to DOJ’s press release:

The United States has partially intervened in a False Claims Act lawsuit against William M. Kelly, M.D. Inc. and Omega Imaging Inc. in the U.S. District Court for the Central District of California, the Department of Justice announced today.  The government intervened as to allegations that the defendants, which operate 11 radiology facilities in Southern California, violated the False Claims Act by submitting claims to Medicare for unsupervised radiology services and services provided at unaccredited facilities.     

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Medicare requires that certain procedures, such as CT and MRI scans that involve intravenous contrast materials, be performed under “direct physician supervision,” which means that a physician must be present within the office suite during the procedure.  The lawsuit alleges that that defendants performed and billed Medicare for contrast procedures without the proper physician supervision.  The suit further alleges that certain of the defendants’ facilities lacked accreditation, which is a material Medicare billing requirement. 

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