VirtuOx, Inc., based in Coral Springs, Florida and operating Medicare approved Independent Diagnostic Testing Facilities (“IDTF”), has agreed to pay $3,150,000.00 to resolve allegations that it submitted or caused to be submitted false claims to Medicare for reimbursement. The United States alleged that, from January 2016 to December 2020, VirtuOx violated the False Claims Act by falsely identifying the place of service for certain services it performed to obtain a higher rate of reimbursement from Medicare. In particular, the United States alleged that, in connection with its billing for overnight pulse oximetry claims, VirtuOx knowingly submitted false claims to Medicare identifying its IDTF located in San Francisco, California as the location of service for overnight pulse oximetry tests when, in fact, no services were performed at that location in relation to the overnight oximetry claims.
The United States further alleged that, from January 2016 to December 2020, VirtuOx administered overnight pulse oximetry tests and, at times, also billed Medicare for single determination pulse oximetry tests (commonly referred to as an oxygen “spot check”) for the same patient when in fact the only test performed was the overnight test. In particular, the United States alleged that, because an awake reading is necessarily taken as part of an overnight pulse oximetry test, the separate billing of a “spot check” is redundant and generally not necessary. Accordingly, the United States alleged that VirtuOx knowingly submitted false claims by separately billing for both an oxygen “spot check” and an overnight pulse oximetry test when only an overnight pulse oximetry test was performed.
Contemporaneous with the civil settlement, VirtuOx entered into a Corporate Integrity Agreement (CIA) with the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG). The five-year CIA requires, among other things, that VirtuOx retain an outside expert to perform annual claims reviews that address the place of service identified on the claim.
