The Department of Justice has announced a $2.3 million settlement for alleged double billing violations of the False Claims Act.  According to the DOJ press release, a children’s genetic services clinic agreed to pay $1.5 million and a radiology group that read and interpreted genetic ultrasounds for the clinic agreed to pay an additional $800,000 to settle the alleged FCA violations. The settlement resolved a qui tam case brought by the radiology group’s former revenue manager and coding compliance officer under the FCA. 

At issue in the DOJ case was alleged double billing for reading and interpreting genetic ultrasounds.  The clinic and the radiology group had an understanding that the clinic would bill and receive payment solely for the “technical component” of this service while the radiology group would bill and receive payment solely for the “professional component.”  Notwithstanding this understanding, the clinic allegedly was billing and receiving payment for both the technical and the professional components.  According to the allegations, the radiology group discovered this double billing and brought it to the clinic’s attention.  The clinic denied that it billed for the professional component, except in a few accidental and isolated instances, and instructed the radiology group to continue to bill for the professional component.

According to the DOJ release, the radiology group continued to do just that, accepting the clinic’s apparent misrepresentation that it was not billing for that component even though there was evidence the clinic continued to bill for the same professional component for which the radiology group was billing. 

Lesson Learned: Turning a blind eye to suspected fraudulent billing in a business arrangement between providers can have serious consequences even if an organization is billing only for services it actually rendered. In the fiscal year that ended on September 30, 2012, the DOJ secured $4.9 billion in FCA settlements and civil judgments. Organizations should consider consulting legal counsel if an employee or business partner reports a FCA violation or they suspect a FCA violation.

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Photo of Michael R. Bertoncini Michael R. Bertoncini

Michael R. Bertoncini is a principal in the Boston, Massachusetts, office of Jackson Lewis. He is a member of the Healthcare industry group and a member of the Higher Education group.

With a background as a former Deputy General Counsel, Michael understands first-hand…

Michael R. Bertoncini is a principal in the Boston, Massachusetts, office of Jackson Lewis. He is a member of the Healthcare industry group and a member of the Higher Education group.

With a background as a former Deputy General Counsel, Michael understands first-hand the competing demands and unique challenges faced by in-house counsel. Before joining Jackson Lewis, he was responsible for all labor and employment law matters for the largest fully integrated community care hospital system in New England. Michael provides timely, practical advice that helps clients achieve their strategic goals while ensuring compliance with legal obligations.

With deep experience in a broad range of industries, Michael has a keen interest in the healthcare, higher education, museum, and arts & music sectors. He is dedicated to supporting clients in these areas, leveraging his extensive experience to address the specific challenges faced by institutions and organizations in these fields.

Michael regularly partners with clients to establish positive employee relations. In labor relations matters, he negotiates collective bargaining agreements on behalf of organized clients, represents clients in labor arbitrations and National Labor Relations Board proceedings, and counsels clients with respect to rights and obligations under collective bargaining agreements and applicable labor and employment laws. He also has extensive experience in advising organizations responding to corporate campaigns and negotiating neutrality agreements.

Michael’s privacy and data security practice focuses on advising clients on complying with HIPAA and other state and federal privacy and data security laws. He reviews and develops policies and procedures, written information security plans and integrated compliance programs to ensure his clients meet their obligations under privacy and data security laws. Michael represents clients in investigations of alleged data breaches and advises them on reporting obligations.. He also conducts workplace training programs on HIPAA compliance and related privacy and data security topics.