Imaging center, partner hospital agree to pay $2M to settle False Claims Act case
A Maryland imaging center and its partner hospital have agreed to pay more than $2 million to resolve allegations that they violated the False Claims Act, the Department of Justice announced Monday.
Diagnostic Imaging Associates and Doctors Community Medical Center had a long-standing pact whereby the radiology group would bill CMS using its own assigned provider number. It did so for both the professional services provided by Diagnostic Imaging Associates, along with the technical component, rendered at the hospital’s outpatient cancer screening facility.
However, the breast center was not enrolled in the two federal payment programs and should not have entered these arrangements, the DOJ said in an announcement.
“The resolution in this matter demonstrates the commitment of the United States Attorney’s Office to rigorously protect Medicare and Medicaid from those who would flout the regulations prescribed by those programs for the reimbursement of medical care,” U.S. Attorney Erek L. Barron said in a statement.
Luminis Health acquired Doctors Community Medical Center in summer 2019. And its compliance department later discovered that the breast center was using the wrong provider number to bill for certain services, a spokesman said Tuesday. The Annapolis, Md., health system immediately investigated the matter, fixed the problem and self-disclosed its actions to HHS.
“Luminis Health has a robust compliance program that seeks to prevent, identify and mitigate potential activity that does not comply with health regulations,” Media Relations Strategist Justin McLeod told Radiology Business Tuesday. “This self-disclosure demonstrates our commitment and effectiveness of our proactive compliance program.”
The outpatient breast center delivered services including radiation oncology, biopsies, mammography and bone density screenings. Diagnostic Imaging Associates—which also has since been acquired by Luminis Health—provided diagnostic and interventional radiology services, including interpreting the exams. Meanwhile, the hospital provided any necessary technical equipment, office space, technologists and supplies needed to facilitate this work.
Under the pact, tests performed at the outpatient location were supposed to be billed by the breast center on a global-fee basis using its own provider number. Diagnostic Imaging Associates was to be paid a percentage of the total reimbursement for performing the professional component (interpreting the images), the DOJ noted. But the breast center failed to obtain its own provider numbers to bill Medicare and Medicaid. During a 10-year period ending in 2020, Diagnostic Imaging Associates, instead, submitted the claims to CMS using its own supplier number to bill for both the professional and technical component of the center’s services.
“Both the hospital and DIA knew that the center did not have a billing number as required by Medicare and Medicaid to be eligible for reimbursement for rendered medical services,” the Department of Justice said in its announcement.
The claims are only allegations, with Luminis Health’s payment not constituting an admission of guilt. Both Doctors Community Medical Center and Diagnostic Imaging Associates cooperated throughout the investigation, federal officials noted.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.