Large
Kidney Dialysis Clinic Operator Resolves Fraudulent Billing Allegations
for $5.2 Million
U.S. Attorneys recently announced that the largest operator of kidney dialysis clinics in the U.S. has agreed to pay $5.2 million to resolve allegations that they tested dialysis patients for Hepatitis B surface antigen more frequently than medically necessary and then billed Medicare for the unnecessary tests.
Patients suffering from End Stage Renal Disease (ESRD) and Chronic Renal Disease (CRD) require dialysis treatments 3-4 times a week because their kidneys no longer can perform some functions naturally. Certain ESRD and CRD patients are at risk of contracting Hepatitis B, a virus-borne disease that affects the liver. Medicare established a testing frequency schedule for dialysis clinics to follow for reimbursement. The schedule depends upon each patient’s immunity to Hepatitis B infection, and that immunity is determined by a Hepatitis B antibody test. The dialysis clinic was accused of conducting and billing Medicare for tests of patients the clinic knew were immune to the Hepatitis B during the period from Feb. 10, 2003 through Dec. 31, 2010. It was also reported that the company performed and billed Medicare for these tests on immune patients against their treating physicians’ orders and without any accompanying documentation for medical necessity.
A former employee brought the allegations to the attention of the government through a whistleblower lawsuit.
Compliance Perspective
Failure to monitor and ensure that testing performed by the dialysis provider for residents with ESRD or CRD adheres to attending physicians’ orders, whether it is performed by an in-house or outside provider, may result in the submission of false claims to Medicare, in violation of federal regulations.
Discussion Points:
- Review policy and procedure guidelines for residents receiving dialysis, either in-house or through an outside provider, to ensure that protocols address following attending physicians’ orders when testing for Hepatitis B, including for those known to be immune, and that copies of supporting documentation for testing are provided to the nursing home.
- Train staff to be aware of physicians’ orders regarding residents receiving dialysis and instructions that known immune patients not be tested.
- Periodically audit any Hepatitis B testing of patients receiving in-house dialysis to ensure that physicians’ orders are being followed.
