- Improperly Supervised Diagnostic Imaging Constitutes False Claims
- October 12, 2011 | Author: Edgar C. Morrison
- Law Firm: Jackson Walker L.L.P. - San Antonio Office
A federal court in the middle district of Tennessee has granted a $10 million judgment against a medical imaging company for causing false claims to be submitted to the Medicare program, after evidence showed that the company failed to have a properly certified physician present during dye contrast imaging studies as required under Medicare regulations. The case involves MedQuest Associates, Inc., an imaging company operating in 13 states. The case was brought by an ex-employee who witnessed MedQuest providing services without the requisite physician supervision.
Medicare regulations specify three levels of supervision for imaging services furnished and paid under the Physician Fee Schedule, including at independent diagnostic testing facilities ("IDTFs") like MedQuest. General supervision requires no actual physician presence, but simply overall supervision of staff and equipment. Direct supervision is required for more complex studies, including the contrast studies involved in this case, and requires that a trained physician be present and immediately available on the premises where the studies are being performed. Finally, very complex procedures require personal supervision, which means that a trained physician must be present in the procedure room during the time that the study is being performed.
Medicare regulations also require each IDTF to have a supervising physician, and require that supervising physician to be qualified to perform and supervise all of the procedures performed by the IDTF. Thus, while Medicare does not mandate that a board certified radiologist be the supervising physician of an IDTF, a physician must possess extensive significant training in all of the procedures performed by the IDTF in order to qualify as a supervising physician. The Tennessee court ruled that the imaging center failed to supervise imaging procedures with physicians with the requisite level of training and experience in such procedures.
Providers paid for imaging procedures under the physician fee schedule should take note of the MedQuest case, as the qui tam relator (i.e., whistleblower) was able to persuade the government, which in turn was able to persuade the district court, that failure to adequately document that imaging procedures were performed under the appropriate level of supervision of a trained and experienced, qualified, supervising physician amounts to a false claim under the False Claims Act. The defendant in the MedQuest case will be required to pay over $10 million. That is the consequence of improper physician supervision.