WASHINGTON, April 14 /PRNewswire-USNewswire/ -- A board-certified radiologist, Fred Steinberg, M.D., his imaging centers and related entities in Palm Beach County, Fla., have reached a settlement with the United States to resolve allegations of health care fraud, the Justice Department announced today. Under the terms of the settlement, the U.S. recovered $7 million.
The settlement resolves allegations that portions of CT scans were not performed, even though the procedures were billed and reported to patients' physicians as if they were done. CT scans, which take detailed pictures of structures inside the body, are often taken using a dye (or contrast material) to highlight certain conditions. In addition to performing CT scans with contrast, scans may also be done without contrast. The bills submitted by Steinberg and his entities to federal healthcare programs, including Medicare, reflected that thousands of CT scans were carried out both with and without contrast, when in reality the CT scans without contrast were not performed. In addition, the government alleged that the Steinberg entities did CT scans and ultrasound exams that were not ordered by physicians and were not medically necessary.
The settlement also resolves allegations that financial inducements were paid to physicians for patient referrals, which are prohibited under the Stark law and the Anti-Kickback statute. These inducements took the form of medical directorship, clinical research, employment, facility use and equipment lease agreements that exceeded fair market value or otherwise failed to comply with federal law.
"This settlement confirms our vigorous pursuit of allegations of fraud and abuse in federal healthcare programs, against both companies and individuals," said Jeffrey S. Bucholtz, acting Assistant Attorney General for the Department of Justice's Civil Division. "All participants in these programs must abide by the government's requirements for the provision of care and proper billing, and this settlement reflects the importance the Department places on compliance with the law, including those laws governing prohibited financial relationships."
The United States initiated the investigation in response to a whistleblower action under the False Claims Act brought by David Clayman, M.D., a former employee of one of the Steinberg group practices. Under the False Claims Act, private individuals can bring actions for fraud on behalf of the United States and collect a share of any proceeds recovered by the suit. As a result of today's settlement, the whistleblower will receive $1.75 million as his share of the recovery.
"Billing Medicare for tests that are either not medically necessary or not performed is an abuse of the Medicare program that squanders scarce dollars," said R. Alexander Acosta, U.S. Attorney for the Southern District of Florida. "We will aggressively prosecute any physicians, including board-certified specialists, who abuse and steal from the Medicare system to line their own pockets."
The case was handled jointly by the Justice Department's Civil Division and the U.S. Attorney's Office for the Southern District of Florida, with investigative assistance provided by the Office of the Inspector General, Department of Health and Human Services; the Office of Personnel and Management; and the U.S. Postal Service.
The case is entitled U.S. ex rel. David Clayman v. University MRI and Fred Steinberg, M.D. et al. Civil Action No. 02-81143 (S.D. Fla.).
SOURCE U.S. Department of Justice