The Wall Street Journal reports today that a Florida medical-imaging center operator will pay $7 million to settle accusations that it billed CT scans not performed and offered doctors kickbacks for patient referrals. The radiologist whistleblower in the case, David Clayman, will receive $1.75 million for his efforts in the case.
Last February, the Chicago Tribune reported — in relation to the same case — an example of the kind of deal offered to doctors:
Dr. Fred Steinberg, a prominent Boca Raton radiologist and imaging center operator, allegedly made a Florida chiropractor a lucrative offer back in April 2000: Pay as little as $400 for every basic MRI done at his facility, bill insurance companies up to $2,300 and pocket the difference.
That deal had the potential to be worth more than $30,000 a month for the chiropractor, who under a lease agreement would be allowed up to 20 high-resolution scans. But Steinberg, owner of University MRI & Diagnostic Imaging Centers, offered it with a note of caution: “This rate is below our usual rate and I need you to keep this confidential,” he wrote to the chiropractor.
As the WSJ ports, “the University MRI facilities also did CT scans and ultrasound exams that were not ordered by physicians and were not medically necessary. In other cases, the facilities billed for CT scans that it never performed.”
In federal False Claims Act cases, whistleblowers are typically granted between 15 and 30 percent of the governments recovery. Federal statute provides for recovery of trebled actual damages (meaning the actual over-billings multiplied by three) plus between $5,500 and $11,000 for each false billing submitted to the government. Because of the multiplicity of claims in a medical services setting, the government’s potential recovery in a Medicare case can quickly reach high levels. In some states, state false claims statutes provide an additional recovery mechanism with respect to the Medicaid.