Sixteen separate cardiology practices and associated physicians, located across 12 states, have agreed to pay amounts totaling $17,761,564 to resolve allegations that they each violated the False Claims Act by overbilling Medicare for diagnostic radiopharmaceuticals. Diagnostic radiopharmaceuticals are radioisotopes bound to biological molecules that target specific organs, tissues or cells within the human body and are used to diagnose and, in some cases, treat certain cancers and diseases. In 13 states and the District of Columbia, Medicare Part B reimburses healthcare providers for diagnostic radiopharmaceuticals based on the provider’s acquisition cost. In those jurisdictions, Medicare’s contractors have published guidance explaining the reimbursement methodology and providers’ obligation to accurately report their invoice costs for diagnostic radiopharmaceuticals. The government alleged that the settling cardiology practices regularly reported inflated acquisition costs to Medicare for these drugs. In each of the settlements, the conduct occurred for at least a year, and in some instances, the conduct extended over a period of more than 10 years.
