United States Attorney Maria Chapa Lopez announces today that Mori, Bean and Brooks, P.A. (MBB), a radiology practice in the Jacksonville, Florida area, has agreed to pay the United States $1.4 million to resolve allegations that it knowingly submitted false claims to Medicare and Medicaid for radiological images that were ineligible for reimbursement.
“Today’s announcement demonstrates the Justice Department’s commitment to protect public funds and our healthcare beneficiaries,” said United States Attorney Chapa Lopez. “We will aggressively pursue healthcare providers who violate Medicare regulations and hold accountable providers who knowingly submit fraudulent claims to Medicare and Medicaid.”
The settlement resolves allegations that from April 27, 2012, through February 5, 2019, MBB billed healthcare programs for radiological images that were interpreted outside the United States. Medicare requires that for tele-radiology services to be eligible for reimbursement, they must be performed within the United States. The agreement also resolves allegations that the practice group billed for radiology services that were initially performed overseas but were re-interpreted by another radiologist in the U.S. and billed to the second, domestic radiologist as if the latter doctor had performed the original read.
“Knowingly submitting false claims for financial gain is unacceptable,” said Special Agent in Charge Omar Perez Aybar of the U.S. Health and Human Services, Office of Inspector General. “Medicare only pays for services provided in accordance with Medicare rules. Today’s settlement should serve as a warning that anyone attempting to defraud taxpayer-funded health care programs will be vigorously pursued. ”
While MBB continued to bill Medicare and Medicaid for reads performed outside the country until after the United States informed it of the ongoing investigation, after being informed of the investigation MBB successfully reduced the amount owed to the government through diligent and effective cooperation.
This case was handled by Assistant U.S. Attorneys Shea Gibbons and Sean Keefe for the Middle District of Florida. It was investigated by the U.S. Department of Health and Human Services – Office of Inspector General.
The settlement concludes a lawsuit originally filed in the United States District Court for the Middle District of Florida by Thomas Heyck, a radiologist who formerly worked for Mori, Bean and Brooks. Heyck sued under the qui tam, or whistleblower, provisions of the False Claims Act permitting a private citizen to sue on behalf of the United States for false claims and to share in the recovery. The case is captioned U.S. ex rel. Thomas Heyck v. Mori, Bean and Brooks, P.A, No. 3:18-cv-590-J-39PDB. The Act also allows the United States to intervene and prosecute the action. Heyck will receive 19% of the proceeds from the settlement.