by Ben Vernia | December 22nd, 2022
On December 20, the Department of Justice announced that a Pennsylvania company and its subsidiary had agreed to pay nearly $45 million to settle two whistleblowers’ allegations that the companies defrauded federal healthcare programs related to remote cardiac monitoring services. The company is also entering into a five-year Corporate Integrity Agreement with the Department of Health and Human Services Office of Inspector General. According to DOJ’s press release:
BioTelemetry Inc. and its subsidiary CardioNet LLC, both headquartered in Pennsylvania (collectively “BioTelemetry”), have agreed to pay $44,875,000 to resolve allegations that they violated the False Claims Act by knowingly submitting claims to Medicare, TRICARE, the Veterans Health Administration, and the Federal Employee Health Benefits Program for heart monitoring tests that were performed, in part, outside the United States, and in many cases by technicians who were not qualified to perform such tests.
The United States alleged that CardioNet improperly billed Medicare and other federal health care programs for certain cardiac monitoring services — including Holter, event monitoring, and mobile cardiovascular telemetry (MCT) tests — that were performed overseas in violation of federal law that prohibits payment for services furnished outside the United States. More specifically, the government alleged that, in 2013, CardioNet contracted with a company located in India for the provision of diagnostic and analysis services of heart monitoring data. Although BioTelemetry set up a workflow that was designed to route electrocardiogram data, including data relating to cardiac events (ECG Data) for federal healthcare beneficiaries, to a domestic independent diagnostic testing facility for review and analysis, the government alleged that BioTelemetry — with the knowledge of then senior management — diverted certain federal beneficiaries’ ECG Data to India when the domestic workflow became backlogged. BioTelemetry also allegedly sent ECG data for other federal beneficiaries directly to India for review. In 2014, over 29% of the ECG Data reviewed in connection with MCT tests, and over 78% of the ECG Data reviewed in connection with event monitoring tests, for Medicare patients were allegedly reviewed by technicians located in India. In 2015, those numbers allegedly rose to over 47% and over 88%, respectively. Although BioTelemetry began implementing technological controls in late 2015 to prevent personnel in India from accessing the domestic workflow, those controls were insufficient, and technicians in India allegedly continued to review and analyze some ECG Data for federal healthcare program beneficiaries thereafter.
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The United States further alleged that most of the offshore technicians tasked with reviewing ECG Data for federal healthcare program beneficiaries did not have the basic qualifications to perform the tests in question. Of the more than 450 India-based technicians who reviewed Medicare patients’ ECG Data in connection with MCT services that CardioNet billed to Medicare during the 2013 to 2018 period, the government alleged that fewer than 3% were certified by Cardiovascular Credentialing International (CCI), the only recognized credentialing body for such cardiovascular technicians.
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The pair of whistleblower, both former employees of the subsidiary, will share approximately $8.3 million (a relators’ share of approximately 18.5%).
