Adventist, BioTelemetry reach False Claims Act settlements

Two nationally recognized healthcare companies settled separate multimillion dollar claims tied to False Claims Act (FCA) violations, highlighting the continued scrutiny that providers face from federal regulators.  

BioTelemetry Inc., which specializes in heart monitoring equipment, agreed to pay $6.4 million to settle allegations that its subsidiary, CardioNet, overbilled Medicare for Mobile Cardiac Outpatient Telemetry (MCOT) services that were medically unnecessary, according to a Department of Justice (DOJ) statement.

MCOT monitors, which are worn by patients to record irregular rhythms or cardiac events, are not eligible for Medicare reimbursement when used for patients with mild or moderate heart palpitations, since less expensive options are available. Although CardioNet was aware of this ineligibility, the company still allegedly billed Medicare for this service and submitted an inaccurate diagnostic code.

"Billing for a higher-level service that is not necessary to treat a patient's condition to receive higher reimbursement from federal healthcare programs will not be tolerated," Acting Assistant Attorney General Benjamin C. Mizer of the Justice Department's Civil Division said in the statement. "Such conduct wastes critical federal healthcare program funds and drives up the costs of health care for all of us."

On the same day, Adventist Health System Sunbelt Healthcare Corp., which operates a network of 45 hospitals in 10 states, settled false claims allegations for $5.4 million, according to the DOJ. Federal prosecutors alleged that the health system billed Medicare and TRICARE for unsupervised radiation oncology services in hospitals throughout Florida between 2010 and 2013. Radiation oncology services must be performed by a certified radiation oncologist.

Adventist has a long history of false claims settlements. In 2013, the system agreed to pay $14.1 million to settle FCA allegations that one of its hospitals paid kickbacks to physicians at a rate above fair market value for residency teaching services. The year prior, Adventist paid $3.9 million because four Florida hospitals submitted false claims for spinal fracture surgical procedures. That same year, the Adventist faced allegations it misused billing codes to increase reimbursement.

As FierceHealthPayer: AntiFraud reported last week, legal reports indicate FCA scrutiny is showing no signs of letting up following a record-breaking $5.7 billion in recoveries in 2014. More than $2 billion of that was tied to false claims against federal healthcare programs, and federal prosecutors have showed an increased willingness to intervene in whistleblower lawsuits.

For more:
- here's the BioTelemetry statement
- read the Adventist statement