Jacksonville radiology clinic Mori, Bean and Brooks agreed Nov. 20 to pay $1.4 million to resolve allegations that it knowingly submitted false claims to Medicare and Medicaid for radiological images that were ineligible for reimbursement.
According to a news release from the U.S. District Attorney, Middle District of Florida, the settlement resolves allegations that from April 2012 through February 2019, the clinic billed health care programs for radiological images that were interpreted outside the U.S.
For teleradiology services to be eligible for reimbursement, Medicare requires that the work be performed within the U.S.
The agreement also resolves allegations that the practice group billed for radiology services that initially were performed overseas but were reinterpreted by another radiologist in the U.S. and billed to the second, domestic radiologist as if the latter doctor had performed the original read.
While the clinic continued to bill Medicare and Medicaid for reads performed outside the country until after the government informed it of the ongoing investigation, after being informed of the investigation, the clinic successfully reduced the amount owed to the government through diligent and effective cooperation, according to the release.
The settlement concludes a lawsuit originally filed in the U.S. District Court for the Middle District of Florida by Thomas Heyck, a radiologist who formerly worked for Mori, Bean and Brooks.
Heyck sued under the qui tam, or whistleblower, provisions of the False Claims Act permitting a private citizen to sue on behalf of the government for false claims and to share in the recovery. Heyck will receive 19% of the proceeds from the settlement.