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.

Tags: "$2.3 million", "$4.9 billion", "double billing", "False Claims Act", "qui tam", billing, FCA, fraudulent, settlement
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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 P.C. He practices labor and employment law, with a particular emphasis on labor relations, employment law counseling and litigation, and data privacy and security law.

In labor relations matters…

Michael R. Bertoncini is a Principal in the Boston, Massachusetts, office of Jackson Lewis P.C. He practices labor and employment law, with a particular emphasis on labor relations, employment law counseling and litigation, and data privacy and security law.

In labor relations matters, he regularly counsels clients on the practice of positive employee relations, 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.

Mr. Bertoncini’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 regularly reviews and develops policies and procedures, written information security plans and integrated compliance programs to assist clients in meeting their obligations under privacy and data security laws. Mr. Bertoncini has represented clients in investigations of alleged data breaches and advises them on their reporting obligations in the event of a data breach. He also conducts workplace training programs on HIPAA compliance and related privacy and data security topics.

Before joining Jackson Lewis, Mr. Bertoncini was Deputy General Counsel for a hospital system that is the largest fully integrated community care organization in New England. He was responsible for all of the system’s labor and employment law matters, and was involved in its acquisition by a private equity firm as well as its growth from six to ten hospitals in a twelve-month period. His three years as in-house counsel for this large health care system give Mr. Bertoncini a keen understanding of the impact of labor and employment law issues on clients’ business operations.

In addition to his labor relations and privacy experience, Mr. Bertoncini has extensive experience in conducting internal investigations and counseling clients on whistleblower and retaliation matters, as well as negotiating executive agreements, both employment and separation agreements. Mr. Bertoncini also represents clients in the litigation of employment matters. His litigation experience includes matters before federal and state courts and administrative agencies. He has appeared before United States Courts of Appeals and District Courts, Massachusetts and New York state courts, the Equal Employment Opportunity Commission, and the Massachusetts Commission Against Discrimination.

Mr. Bertoncini is a frequent speaker and trainer on labor and employment law topics for various organizations including Massachusetts Continuing Legal Education, Council on Education in Management, Lorman Education Services, the Boston Bar Association, and several chambers of commerce.

While attending Boston College, he received the John A. McCarthy, SJ Award for the most distinguished Scholar of the College thesis.

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