Health and Human Services’ Inspector General is looking into portable x-ray services. The government believes there are widespread overbillings within the industry. According to the Inspector General (OIG), they have “identified questionable billing patterns by portable x-ray providers, including billing for services ordered by non-physicians and services that were not medically necessary or adequately documented.” Billing for undocumented or unnecessary services is illegal. Under the federal False Claims Act, folks with inside knowledge of these scams can earn substantial Medicare fraud whistleblower awards.
Recently the OIG conducted a random audit of Precision Health Inc., a provider of portable x-ray services. Over a 22 month period, Precision Health submitted over 97,000 claims for reimbursement. Auditors selected a random, stratified sample of 117 claims for review. Of those, the audit found 29 were improperly paid. That equates to 24.7%, something we often see with radiology providers.
Medicare pays for portable x-ray services including skeletal films of arms, legs, pelvis, spine, skull, chest, and abdomen, as well as electrocardiograms and mammograms. Medicare Part B pays for all services related to the portable x-ray, including transportation of the x-ray equipment to the patient’s residence or nursing home. Interpretation of the results is also included.
For Medicare to cover the services and pay the bills, the portable x-ray services must be medically necessary. They also must be ordered by a physician. The physician’s order must specify the reason why the x-ray is required, the area of the body to be exposed, the number of x-rays to be taken, the views needed, and why portable x-ray services are necessary. Portable x-rays aren’t allowed unless there is a medical reason why the patient can’t travel to the physician’s office or hospital. (As early as 1997, Medicare officials were worried about the cost of portable x-ray services.)
Portable x-ray providers must document and retain the physician orders, films and results in case of an audit.
Before Precision’s audit was final, Medicare questioned almost half of the bills. In many instances, auditors could not find documentation as to who performed the x-rays. Ultimately Precision was able to supply that information. In our experience, this could be evidence of additional fraud. While Precision supplied documentation to cause the OIG to cease questioning many of the disputed items, we have seen other radiology groups using unlicensed technicians. We have also seen Medicare fraud schemes in which the provider bills for more x-rays than actually ordered. Finally, we have seen unlicensed radiologists or radiologists overseas interpreting the x-ray results in violation of Medicare rules.
The final audit report of Precision found just 25% of questionable bills. (Precision still disputes some of the findings.) The audit also just dealt with portable x-rays services. As noted above, there are problems throughout the radiology field.
Medicare Fraud Whistleblower Awards
A healthcare provider violates the False Claims Act when it deliberately submits false billing or knowingly falsely certifies that it is in compliance with Medicare rules. Violations of the act are punishable by penalties of up to $11,000 per false certification and triple damages. If you do the math, a physician group caught violating the False Claims Act could quickly owe millions in penalties.
Under the act, the whistleblower (called a “relator”) can receive up to 30% of whatever the government collects from wrongdoers. (The most common award is closer to 15% to 20%.) Each year the Justice Department issues hundreds of millions of dollars in awards.
To claim an award, don’t call a Medicare fraud hotline! The hotlines can typically only pay an award of up to $1000. The real awards are paid through the False Claims Act. That requires filing a sealed complaint in federal court. It may sound like a lot of work (and it is) but that work can and should be done by the lawyers.
While the case is being investigated, it remains under seal meaning it is secret and not even the wrongdoer knows that a complaint has been filed, let alone who filed it. Ultimately the case is unsealed when the investigation is complete.
Precision Health Inc. is not a False Claims Act case. They may have to pay back money to Medicare but they were not prosecuted. It is an audit case, not a case filed by a whistleblower. Most Medicare fraud False Claims Act cases are started by whistleblowers and are not the result of a random audit. We share the story of Precision, however, as a cautionary tale about just how widespread Medicare fraud and billing improprieties are in the portable x-ray field of medicine.
How to Claim Your Own Medicare Fraud Whistleblower Award
The False Claims Act lawyers at MahanyLaw have helped whistleblowers recover over $100 million in awards. That also means we have helped whistleblowers stop huge frauds and helped the government collect billions of dollars on behalf of taxpayers. If you have inside information about Medicare or Medicaid fraud or other frauds against the government, give us a call. Our consultations are free, confidential and protected by the attorney – client privilege. We do not charge for our services unless you first win and recover money.
For more information, contact attorney Brian Mahany at or by telephone at (direct). You can also visit our Medicare fraud whistleblower information page here.
MahanyLaw – America’s Medicare Fraud Whistleblower Lawyers