A Florida radiology center recently agreed to settle fraud allegations made by the US Department of Health and Human Services Office of Inspector General (OIG) for $501,000. The allegations claimed that the radiology center had violated the False Claims Act by submitting fraudulent claims to Medicare and Tricare, a healthcare program for uniformed service members, retires, and their families.
As part of the settlement, the United States contends that the radiology center knowingly submitted claims to Medicare and Tricare by (1) administering dye-contrast scans without direct physician supervision as required by Federal regulations, and (2) improperly billing for services performed by doctors who were not properly credentialed by Medicare.
The claims resolved by the settlement are allegations only, and there has been no determination of liability. The civil settlement also resolves several other captioned cases.
Compliance Perspective
Issue
Using radiology centers or other providers who employ staff who are not properly credentialed by Medicare and who fail to provide direct physician supervision of employees as required by federal regulations may place the facility at risk for sanctions, including possible exclusion as a Medicare/Medicaid provider.
Discussion Points
- Review policies and procedures regarding performing background checks on vendors to ensure they are in compliance with federal regulations and not listed as excluded individuals or entities.
- Train responsible staff to perform vendor background and Medicare exclusion checks and have completed contracts on file.
- Periodically audit to determine if vendors are being properly evaluated and have current contracts on file.
FOR MORE INFORMATION ON THIS TOPIC view: FRAUD MODULE 10 – VENDOR CONTRACTS and STAYING ON TOP OF EMPLOYEE CHECKS.
