California doctor, radiology practices pay $5 million over claims for unsupervised, unaccredited services

by Ben Vernia | September 10th, 2020

On September 9, the Department of Justice announced that a Southern California radiologist and a large radiology practice had agreed to pay $5 million to settle a whistleblower’s allegations that they submited false claims for radiology services. According to DOJ’s press release:

William M. Kelly Inc. and Omega Imaging Inc., together, operate 11 radiology facilities in Southern California, have agreed to pay the United States $5 million to resolve allegations that they violated the False Claims Act (FCA) by knowingly submitting claims to Medicare and the military healthcare program, TRICARE, for unsupervised radiology services and services provided at unaccredited facilities, the Department of Justice announced today.

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The settlement resolves allegations that the defendants submitted claims for CT scans and MRIs involving contrast injections that were not properly supervised by a physician.  Applicable program rules require a physician to be present in the office suite when a patient undergoes an examination that involves the administration of intravenous contrast material.  The defendants allegedly performed and billed for these procedures when no supervising physician was present in the office suite.  The settlement also resolves allegations that a certain number of the defendants’ facilities lacked accreditation.

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The government also announced that the whistleblower, a former practice employee, will receive $925,000 (an 18.5% relator’s share). The defendants have also agreed to a three-year corporate integrity agreement with the Department of Health and Human Services Office of Inspector General.

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