Texas MD groups agree to $2.3M settlement in imaging double-billing suit

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 - Gavel

The U.S. Attorney’s office has settled a federal lawsuit brought against a pair of Corpus Christi, Texas-based physician groups, according to a release from the U.S. Attorney for the Southern District of Texas.

Children’s Physician Services of South Texas (CPSST), part of Driscoll Health System, and Radiology Associates have agreed to pay a combined $2.3 million to settle allegations that the groups both billed the government for the professional component of the same genetic ultrasound procedures over a span of five years. Prosecutors had pegged the alleged wrongful reimbursements as amounting to at least $12.3 million, according to a report from local NBC affiliate KRIS-TV.

Driscoll Health System agreed to pay $1.5 million and Radiology Associates agreed to pay $800,000.

CPSST allegedly billed and received payment for Radiology Associates’ professional services and, without disclosing the payments, directed Radiology Associates to bill and receive payment for the same professional services.

Radiology Associates ignored evidence of double-billing in continuing to receive professional component payments and “accepted CPSST’s misrepresentations without question,” according to the U.S. Attorney’s office.

The suit was filed qui tam in 2008 by a former revenue manager and coding compliance officer with Radiology Associates, meaning the whistleblower will share between 15 to 25 percent of the proceeds of the overall settlement for bringing suit on behalf of the government.  

"Improper double-billing by healthcare providers defrauds the government funded health care programs, adds to the government's deficit, and, most importantly, reduces the funds available to meet the patients' medical needs," U.S. Attorney Kenneth Magdison said in the release.