A California physician and a medical imaging firm are facing allegations in Federal court of Medicare fraud after investigators say the two defendants conspired to submit claims for unsupervised tests at unaccredited facilities.
According to investigators, the defendant physician ordered imaging procedures, including CT and MRI scans, that involved intravenous injections of contrast materials that aid in clearer imaging during such procedures. Due to the nature of such procedures, Medicare requires that they be conducted under direct physician supervision in order to have a medical professional present in case of any complications.
However, investigators say the defendant doctor ordered such scans but was not present for them, subsequently billing Medicare for the procedures. In addition, investigators allege that the facilities themselves were not licensed or accredited to carry out such procedures, making the act of billing Medicare for procedures conducted in such facilities a crime as well.
The suit in question, in which the United States has partially intervened, was brought under the qui tam provisions of the False Claims Act (a/k/a “Lincoln’s Law”), which allows whistleblowers to bring suit initially, with the Federal government coming in and prosecuting the case to its conclusion after investigating the merits of the claims itself.
The case is currently being heard in the U.S. District Court for the Central District of California and is being prosecuted by the Department of Justice’s Civil Division in conjunction with the Office of Inspector General of the Department of Health and Human Services.
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