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Radiologists Will Pay in $2.3 Million Fraud Case

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Two medical practices in Corpus Christi, Texas, including a radiology group, have agreed—although, apparently, grudgingly—to pay $2.3 million for double-billing Medicare for obstetric ultrasounds.

Kenneth Magidson, U.S. attorney for the Southern District of Texas, announced on Tuesday that Children’s Physician Services of South Texas (CPSST) would pay $1.5 million and Radiology Associates would pay $800,000. Children’s Physician Services is affiliated with Driscoll Children’s Hospital/Driscoll Health System of Corpus Christi. Radiology Associates is an independent physician group serving the Driscoll Health System.

According to KRIS-TV in Corpus Christi, a statement released by William Larsen, spokesman for Driscoll Children’s Hospital, called the accusations a “matter of interpretation.” The statement said the hospital system decided to settle the case “to avoid the delay, uncertainty, inconvenience, and expense of protracted litigation.” Not exactly a mea culpa.

In contrast, Magidson evinced no doubt about the guilt of those accused. His statement said:

In addition to yielding a substantial recovery for taxpayers, this settlement should serve notice to health care providers that taxpayers will not tolerate, much less accept, paying twice for services rendered to them.

The case involves several thousand ultrasounds performed from January 1, 2002, to June 1, 2007. According to Magidson, Children’s Physician Services was supposed to bill for the technical component, and Radiology Associates was supposed to bill for the professional component. “In reality,” the U.S. attorney’s statement says, “CPSST billed and received payment for both the technical and professional components without informing or disclosing this fact to Radiology Associates.”

At some point, Radiology Associates discovered the double-billing, according to Magidson, but CPSST denied it and told Radiology Associates to continue billing for the professional component. That sounds as if Radiology Associates was an innocent victim. But Magidson said Radiology Associates knew what was going on and did nothing about it. In court papers, prosecutors said, “Both companies apparently knew about the double-billing.”

The situation came to the government’s attention in 2008 when a former revenue manager and coding compliance officer with Radiology Associates filed a whistle-blower lawsuit. The former employee will get between 15 percent and 25 percent of the settlement.

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Related seminar: Fetal and Women’s Imaging: Advances in Ob-Gyn Ultrasound, With Emphasis on the Fetal Heart

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One Response to “Radiologists Will Pay in $2.3 Million Fraud Case”

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