Radiologists to pay $2M in Medicare fraud settlement

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The Office of Inspector General (OIG) for the Department of Health and Human Services has entered into a civil monetary penalty (CMP) settlement with West Valley Imaging Limited Partnership of Las Vegas, and its principals, William L. Boren, MD, and Luke S. Cesaretti, MD, over claims of Medicare fraud.

The defendants will pay $2 million to resolve allegations that they submitted false or fraudulent claims to Medicare, in one of the largest cases OIG has settled under its CMP, according to the American College of Radiology (ACR).

OIG alleged that the radiologists and West Valley intentionally defrauded Medicare by improperly providing diagnostic tests to Medicare beneficiaries without the required treating physicians' orders, billing for certain tests under Current Procedural Terminology codes not supported by the medical records, and failing to satisfy certain other Medicare billing and coverage requirements.

"OIG is committed to holding providers accountable for defrauding the Medicare program," said Inspector General Daniel R. Levinson. "OIG will investigate and pursue enforcement actions against health practitioners who engage in a pattern of billing Medicare for services that were not ordered by the patients' treating physicians."

In conjunction with the $2 million settlement, West Valley entered into a five-year integrity agreement.

While the case was resolved, the defendants contested the OIG's allegations and denied any liability. No civil monetary penalty judgment or finding of liability has been made against the settling parties.