por John R. Fischer
, Senior Reporter | November 25, 2020
Florida radiology practice Mori, Bean and Brooks will pay $1.4 million to settle allegations that it submitted false claims to Medicare and Medicaid for radiological images that it knew were ineligible for reimbursement.
“Medicare only pays for services provided in accordance with Medicare rules. Today’s settlement should serve as a warning that anyone attempting to defraud taxpayer-funded health care programs will be vigorously pursued,” said Special Agent in Charge Omar Perez Aybar of the U.S. Health and Human Services at the Office of Inspector General.
MBB allegedly billed healthcare programs for images interpreted outside the U.S. between April 27 and February 2019. This violates Medicare’s teleradiology policy, which only reimburses for such services performed in the U.S. It also is accused of having a U.S. radiologist reinterpret exams originally interpreted overseas and then billing to the domestic radiologist as the original reader.
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The U.S. government learned of these actions through a lawsuit filed by Thomas Heyck, a former MBB radiologist, in United States District Court for the Middle District of Florida. He sued under the qui tam (whistleblower) provisions of the False Claims Act, which allows private citizens to sue on behalf of the U.S. for false claims and to share in the recovery. Heyck will receive 19% of the proceeds from the settlement.
Upon being informed that the U.S. was investigating these claims, MBB cooperated with the government to reduce the amount it owed. “We will aggressively pursue healthcare providers who violate Medicare regulations and hold accountable providers who knowingly submit fraudulent claims to Medicare and Medicaid,” said U.S. Attorney Chapa Lopez.