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.