The claim alleges that a company operating eleven radiology facilities submitted false claims to Medicare for payment, in violation of the False Claims Act (FCA). According to the complaint, the defendant submitted claims for unsupervised radiology services and services provided at unaccredited facilities.
Medicare requires certain radiological services—like an MRI—to be performed with a physician in the room. Medicare’s payment of such a claim is expressly conditioned on satisfying that requirement. Similarly, it is unlikely that Medicare would knowingly reimburse unaccredited facility for services.
This action was initiated by a whistleblower under the FCA, which allows those who uncover fraud against the government to bring a civil action on its behalf. The Act also awards the whistleblower with a share of any possible recovery.
The case described above is based on allegations only. There has been no determination of liability.