$2M To Settle False Claims Act Case: On March 20, 2023, the U.S. Attorney’s Office for the District of Maryland announced that Luminis Health Doctors Community Medical Center, Inc. (“DCMC”) and Diagnostic Imaging Associates, LLC (“DIA”), both located in Lanham, Maryland, have agreed to pay the United States $2,002,052.17 to resolve allegations that they violated the federal False Claims Act.
DCMC owns and operates a hospital (“Hospital”) that provides acute care services, including radiation oncology and breast health care services. Specifically, the Hospital provides biopsy and mammography services and bone density screenings to diagnose and treat breast cancer and other diseases through an outpatient cancer screening facility (the Center). DIA provides diagnostic and interventional radiology services. DIA executed a written agreement with the Hospital to provide diagnostic and interventional radiology services to the Center, as well as the interpretation of such tests. The Center, through the Hospital, provided the imaging equipment, office space, technicians and supplies to facilitate the performance of the radiology-related tests. The contract between the Hospital and DIA specified that tests performed at the Center would be billed by the Center on a global fee basis under the Center’s provider number, with DIA being paid a percentage of the Medicare or Medicaid reimbursed global fee for performing the professional component, that is, interpreting the tests. A global fee reflects payment for both the technical and professional components of a medical service billed together as a unit.
However, the Center did not obtain its own number under which it could bill Medicare and Medicaid for the services provided to beneficiaries insured by those programs. Between March 15, 2010, and October 19, 2020, by agreement between the Hospital and DIA, DIA submitted claims to Medicare and Medicaid using DIA’s supplier number to bill those programs for both the professional and technical components of the services rendered in the Center even though the Hospital performed the technical component of the Center’s services. Both the Hospital and DIA knew that the Center did not have a billing number as required by Medicare and Medicaid to be eligible for reimbursement for rendered medical services.
The claims resolved by the settlement are allegations. The settlement is not an admission of liability by DCMC and DIA, nor a concession by the United States that its claims are not well founded. The case arose from DCMC’s and DIA’s reporting of the billing arrangement to the United States Department of Health and Human Services Provider Self-Disclosure Protocol; DCMC and DIA cooperated throughout the ensuing federal investigation conducted by the United States Attorney’s Office for the District of Maryland.
If you have information regarding false claims having been submitted to Medicare, Medicaid, TRICARE, other federal health care programs, or to other federal agencies/programs, and the information is not publicly known and no actions have been taken by the government with regard to recovering the false claims, you should promptly consult with a False Claims Act attorney (also known as qui tam attorneys) in your U.S. state who may investigate the basis of your False Claims Act allegations and who may also assist you in bringing a qui tam lawsuit on behalf of the United States, if appropriate, for which you may be entitled to receive a portion of the recovery received by the U.S. government.
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