By a Biometrica staffer
William M. Kelly Inc and Omega Imaging Inc, who together operate 11 radiology facilities in Southern California, have agreed to pay the US $5 million to resolve false claims allegations.
They allegedly violated the False Claims Act (FCA) by knowingly submitting claims to Medicare and the military healthcare program, TRICARE, the US Department of Justice said in a statement. The claims they submitted were for unsupervised radiology services and services provided at unaccredited facilities.
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. A physician has to be present in the office suite when a patient undergoes an examination that involves the administration of intravenous contrast material, according to applicable program rules.
But the defendants allegedly performed and billed for these procedures when no supervising physician was present. The settlement also resolves allegations that a certain number of the defendants’ facilities lacked accreditation.
Along with the settlement, William M. Kelly and Omega Imaging also entered into a three-year Integrity Agreement with the Department of Health and Human Services Office of Inspector General requiring – among other things – a risk assessment and internal review process to identify and address evolving compliance risks. The agreement requires training, auditing, and monitoring designed to address the conduct alleged in the case.
The allegations were originally brought in by a lawsuit filed under the qui tam, or whistleblower, provisions of the FCA by Syd Ackerman, who was formerly employed by the defendants. The FCA allows private parties to sue on behalf of the government for false claims, and to receive a share of any recovery. It also permits the US to intervene in such a lawsuit, as it did in part here. Ackerman will receive around $925,000 of the settlement proceeds.
“Patients rightly expect that medical providers follow the proper procedures and protocol when administering complex treatments to ensure patient safety. Working with our law enforcement partners we remain steadfast in our commitment to uphold the integrity of government health programs.”Timothy B. DeFrancesca, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services