Why the Feds Are Second-Guessing Bills from Mobile X-Ray and Imaging Companies
Over the last two decades, state and federal governments have devoted more resources than ever to investigating health care fraud and initiating enforcement actions. These actions are principally designed to collect money for the government but can also lead to consequences under criminal law.
An increased number of these cases concern radiologists and imaging services especially providers who offer their services on a mobile basis.
The Department of Justice has identified mobile radiology services fraud as an area of top concern, vowing to maintain hawkish oversight of incoming claims from mobile x-ray companies and the like. Indeed, the words portable x-ray and “mobile imaging” are recurrent in DOJ / FBI press conferences and news announcements, which are now detailing major convictions or settlements of health care professionals on a weekly or monthly basis.
Why Mobile Radiology and Why Now
A few factors are at play:
- The Affordable Care Act (ACA, or Obamacare) substantially strengthened the penalties for health care fraud.
- As the health care market evolves, mobile health services account for a growing portion of the claims submitted to CMS nationwide.
- Agents suspect that fraud might be less immediately apparent when committed by mobile care providers. This is because these companies typically serve as vendors for a number of health care clinics, nursing homes, hospitals, and hospices all at once.
- The predictive modeling technology employed by federal audit contractors have identified a pattern of fraudulent claims coming from mobile radiology services providers.
- The federal government continues to receive additional funding for health care crackdowns, opening new offices and expanding budgets wherever possible. This funding makes additional resources available for stringent oversight in emerging health care markets.
- Mobile health is a new and exciting field, one that many patients are only beginning to encounter for the first time. This lends newsworthiness to any “revelations” of fraud within the industry. And newsworthiness always makes for an attractive target at the Justice Department.
In this climate, it is imperative that professionals and executives working in the mobile radiology field be proactive in protecting themselves from investigation. Federal inquiries can have a destructive impact on business operations even if they don’t ultimately lead to enforcement proceedings. A seemingly simple, routine audit can prove extremely disruptive.
As mobile radiology services fraud defense attorneys, it is our job to negotiate with agents, work diligently to end investigations as quickly as possible, keep our clients in business, and fight to reduce any potential penalties. It isn’t uncommon for mobile health care providers to be assessed hundreds of thousands or millions of dollars in back payments for allegedly fraudulent billings enough to put them out of business. But at The Criminal Defense Firm, we’ve helped many of our clients avoid these penalties as well as the criminal charges that can unfold as a result.
Many of these cases involve the False Claims Act.
Fraudulent Medicare Billing and False Claims Act Violations
The False Claims Act is the government’s primary tool for taking action against medical services providers suspected of defrauding Medicaid, Medicare, and TRICARE. It covers a wide range of fraudulent billing practices including:
- Upcoding
- Double billing
- Billing for medical services that were never provided
- Providing excessive or medically unnecessary services
- Providing only basic life-supporting care but billing for additional phantom services at the same time
- Using fraudulent diagnosis coding to justify treatment as emergent or medically necessary
- Unbundling codes
- Any other false or misleading representation intended to defraud a government benefits program
Notably, The False Claims Act contains a qui tam provision under which private parties may name health care providers as defendants in civil lawsuits asserting health care fraud. These actions are filed on behalf of the federal government, which has the option of taking over the case at any time. The government will ultimately share its recovery (if any) with the private individual(s) who file the qui tam lawsuit in the first place.
In the context of mobile radiology, the False Claims Act is most frequently invoked when:
- portable x-ray companies take more x-rays than necessary.
- the provider exaggerates or upcodes the nature of the radiology services performed.
- radiology companies bill for services that were ordered by someone other than a licensed physician (e.g. x-rays ordered by foreign or suspended doctors, technicians, etc.). CMS policy stipulates that radiology orders must be written by licensed U.S. physicians and provide sufficient detail as to the nature of the images to be taken.
In many cases, it is a former employee (or sometimes a patient) who brings a false claim to light, instituting qui tam litigation with an eye toward his or her personal financial rewards if the action prevails.
Unfortunately, False Claims Act cases against mobile x-ray companies often arise from minor billing errors, good-faith misunderstandings about the licensing status of the ordering doctor or the x-ray technician, or genuine disagreements as to whether a service was “medically necessary.”
A mobile radiology services fraud defense lawyer can fight to clear up misunderstandings and end any ongoing investigations.
The Need for Proactive Mobile Radiology Services Fraud Defense
If you work in mobile imaging, please take note of the recent ramp-up in federal fraud investigations that have specifically targeted your industry.
Even if you haven’t done anything wrong, you or your company could be next.
Now is the time to shore up your recordkeeping and begin double-checking your Medicare bills before they’re submitted. Don’t assume that you’ll easily be able to clear up discrepancies after the fact. Be prepared to defend each and every claim as thoroughly documented, ethically coded, and medically necessary.
Talk to an Experienced Attorney for Mobile Radiology Services Fraud Defense Advice
If you are already under investigation for violating the False Claims Act or any other state or federal health care fraud provision, don’t attempt to handle the matter on your own. Often, it is the mistakes or misleading statements made during the investigation process that ultimately get health care companies in trouble.
It is in your best interest to get sound and strategic advice from a seasoned mobile radiology services fraud defense lawyer immediately. Contact The Criminal Defense Firm for a free consultation right away at 866-603-4540.
Medicare Fraud Defense Lawyers for mobile radiologists and business owners in Dallas and across the nation (primary office in Dallas, TX).
This information has been prepared for informational purposes only and does not constitute legal advice. This information may constitute attorney advertising in some jurisdictions. Reading this information does not create an attorney-client relationship. Prior results cannot guarantee a similar future outcome in your case. The Criminal Defense Firm is a Texas professional corporation with headquarters in Dallas.
Brian Kuester offers his extensive experience to counsel companies and individuals under civil or criminal government investigation. When resolution requires litigation, clients choose Mr. Kuester’s proven court and litigation experience.