by Ben Vernia | December 31st, 2023
On December 18, the Department of Justice announced that a company and its subsidiary have agreed to pay nearly $15 million to settle a whistleblower’s allegations that the companies had billed Medicare for higher cost services than ordered by physicians. According to DOJ’s press release:
BioTelemetry Inc. and its subsidiary, LifeWatch Services Inc., headquartered in Malvern, Pennsylvania, and Rosemont, Illinois, respectively, (collectively LifeWatch), have agreed to pay more than $14.7 million to resolve allegations that they violated the False Claims Act by knowingly submitting claims to federal health care programs for a higher level of remote cardiac monitoring than physicians had intended to order or that was medically necessary, thus inflating the level of reimbursement paid to LifeWatch.
The United States alleged that, during the period July 1, 2014, through Dec. 31, 2020, LifeWatch marketed its ACT-3L device (also known as the LifeStar ACT-3L and the MCT-3L) to doctors as being capable of performing three different types of heart monitoring services: holter monitoring, event monitoring and telemetry. Of these, telemetry provided the highest rate of reimbursement. The United States contended that LifeWatch knew the design of their online enrollment portal for the ACT-3L device caused unwitting clinical staff to select options that would enroll the patient in the most expensive service, telemetry, even when the doctor intended to order a less expensive service. The United States also contended that LifeWatch’s sales personnel instructed clinical staff to select the options that resulted in patients being enrolled for telemetry services, even when the sales personnel knew the clinic’s physicians intended to order less costly services. LifeWatch also allegedly disregarded written notes that clinic personnel included in patient enrollments that specifically reflected the treating physicians’ intent to order a service other than telemetry.
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The government announced that the whistleblowers in two separate qui tam complaints will receive a combined $2.57 million (a relators’ share of approximately 17.5%).
