Healthcare Compliance Perspective:
Medicare reimbursement requires medical services be performed in accordance with federal and state licensing requirements.
The U.S. District Court for Delaware entered a judgment in the amount of $16,223,091.38 against an orthopedic and neurological imaging company for submitting false claims for Medicare reimbursement. Under the terms of the judgment, the company’s owner is jointly and severally liable for $6,125,947.13.
The company operates independent diagnostic testing facilities in Delaware and Maryland. The Court granted the United States’ request for default judgment on its complaint, which alleged 
that the company and its owner knowingly submitted false claims to Medicare by administering contrast dye during magnetic resonance imaging (MRI) scans on patients without proper supervision by a physician. Contrast dye is a chemical that is injected intravenously into the body to make certain tissues more clearly visible on an MRI.
The original lawsuit was filed by a former employee of the imaging company under the qui tam provisions of the False Claims Act, which permit private parties to sue on behalf of the United States for false claims for government funds, and to receive a share of any recovery. The False Claims Act permits the government to intervene in such a lawsuit, as was done in this case. Under the terms of the Court’s judgment, the relator (whistleblower) will receive an 18-percent share of the recovery.
