Adding to a relentless trend of Medicare schemes, 16 cardiology practices agreed to pay more than $17.7M to resolve allegations that they overbilled for diagnostic radiopharmaceuticals and violated the False Claims Act.
- In 13 states and D.C., Medicare Part B reimburses providers for radiopharmaceuticals based on self-reported acquisition costs, leaving billing up to the honor system.
- This structure was abused in 12 of these 13 states, highlighting the pervasiveness of cardiac radiopharmaceutical overbilling.
The DOJ accused these practices of reporting “inflated acquisition costs” to Medicare for materials needed to perform cardiovascular imaging.
- Radiopharmaceuticals like sestamibi and tetrofosmin, which are used for cardiac SPECT and CT scans, made up the bulk of overbilling.
- The questionable conduct occurred for at least a year, and in some cases for more than 10 years.
The three largest settlements accounted for nearly two thirds ($11.7M) of the total payment, covering restitution, fines, and accrued interest.
- Western Kentucky Heart & Lung Associates came in first, paying a whopping $6.75M.
- Heart Clinic of Paris paid $2.6M.
- Scranton Cardiovascular Physician Services paid $2.3M.
- Meanwhile, some practices paid as little as $50k to $160k.
- The whistleblowers will make off with $2.7M of the settlement money.
Although the settlements don’t represent an admission of guilt from the practices, they are part of a larger trend of Medicare overbilling that has plagued the U.S. healthcare system. That’s certainly been true within cardiology over the last year.
- Cardiac surgeons at Baylor St. Luke’s fraudulently billed for over 5,000 concurrent surgeries while using residents to perform the procedures.
- Cape Cod Hospital paid an eyewatering $24.3M to resolve billing allegations for pre-TAVR evaluations that didn’t meet requirements.
- An NJ cardiologist submitted $1.9M worth of false claims for office visits that either never happened or were shorter than claimed.
- Cardiac Imaging of Illinois was charged for a kickback scheme that paid referring cardiologists as if they were supervising PET scans when they weren’t.
The Takeaway
While overbilling continues to find new ways to creep into the U.S. healthcare system, the bigger issue is the inevitable strain it puts on Medicare’s ability to help the patients who are actually sick, which begs the question: what will it take for us to stop robbing Peter to pay Paul?
