New York, Feb 26: A diagnostic firm founded by an Indian-American physician has agreed to pay $15.5 million to settle charges that it falsely billed federal and state health care programmes and paid kickbacks to physicians.
The Diagnostic Imaging Group (DIG), founded in 1985 by Mumbai native Leena Doshi, would pay $13.65 million to the federal government and an additional $1.85 million to New York and New Jersey under a settlement announced by officials of the two states.
Doshi herself has not been charged or accused of any wrongdoing.
The DIG, which operates a chain of diagnostic testing facilities through its subsidiary Doshi Diagnostic Imaging Services, headquartered in Hicksville, New York, was charged with billing for tests that were not performed or not medically necessary.
The DIG previously operated chains in New Jersey and Florida through subsidiaries Doshi Diagnostic Imaging Services of New Jersey and Signet Diagnostic Imaging Services, officials said.
The settlement resolves allegations that the DIG submitted claims to Medicare, as well as the New Jersey and New York Medicaid Programmes, for 3D reconstructions of CT scans that were never performed or interpreted.
Additionally, the DIG allegedly bundled certain tests on its order forms so that physicians could not order other tests without ordering the additional bundled tests, which were not medically necessary.
The settlement also resolves allegations that the DIG paid kickbacks to physicians for the referral of diagnostic tests.
According to the government, the kickbacks were in the form of payments that the DIG made to physicians ostensibly to supervise patients who underwent nuclear stress testing.
These payments allegedly exceeded fair market value and were, in fact, intended to reward physicians for their referrals.
“Paying physicians for their referrals and submitting false claims to increase Medicare and Medicaid reimbursements simply cannot be tolerated,” said Daniel R. Levinson, inspector general of the US Department of Health and Human Services.
“Besides levying a hefty penalty, the settlement requires an independent organisation to review Diagnostic Imaging Group’s claims for five years and to send reports to the government.”
The allegations resolved under the settlement were raised in three lawsuits filed in 2009 and 2010 in federal courts under whistleblower provisions of the False Claims Act.
The three whistleblowers will receive a total of $2.77 million as part of the settlement.