A former revenue manager and coding compliance officer for a radiology practice will receive a whistleblower reward of between $345,000 and $575,000 for helping the government uncover double billing of Medicare and Medicaid by his former employer and one of its clients.

The whistleblower went to the government with evidence that Children’s Physician Services of South Texas had billed and received payment for professional services provided by a radiology practice and, without disclosing the payments, directed the radiology practice to bill and receive payment for the same professional services.

Here’s how the fraud worked.  Technicians working for Children’s Physician Services took genetic ultrasounds of patients and sent the resulting images to Radiology Associates for reading and interpretation by a physician.

Children’s Physician Services then billed Medicare and Medicaid for both the taking of the ultrasound and the reading and interpretation of the ultrasound image.  When Radiology Associates billed for its professional services, that resulted in double billing of Medicare and Medicaid for the reading and interpretation of the ultrasound image.

At some point, the government alleged, Radiology Associates learned of the double billing but continued to bill Medicare and Medicaid anyway.

A former coding manager at Radiology Associates ended the fraud – which involved thousands of ultrasound images over a five-year period – by commencing a qui tam or whistleblower lawsuit under the False Claims Act.  The lawsuit was filed “under seal” and disclosed only to local prosecutors.  The prosecutors then conducted an investigation and decided to join in the lawsuit.

Children’s Physician Services and Radiology Associates agreed to settle the lawsuit by paying a total of $2.3 million.  Under the False Claims Act, the former coding manager will receive between 15% and 25% of that amount as his whistleblower reward, for a total reward of between $345,000 and $575,000.

If you are aware of false claims submitted to Medicare or Medicaid, then you should consult with an experienced whistleblower attorney to find out if you may be entitled to a whistleblower reward and legal protections.

To arrange a free and confidential consultation with an experienced whistleblower attorney, call John Howley, Esq. at (212) 601-2728 or click here to reach our office via email.

John Howley, Esq.

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