A radiology group in New York has agreed to pay $8 million to settle claims that it knowingly submitted false claims to Medicare and Medicaid. Federal prosecutors claimed that the provider billed for services provided by physicians not enrolled in the government programs and for services not ordered by a physician.
Some of the false billings resulted from a policy of automatically performing X-rays and ultrasounds on patients without a physician specifically requesting them.
Attorney General Eric T. Schneiderman and United States Attorney Robert L. Capers recently announced the settlement with Zwanger-Pesiri Radiology Group, headquartered in Lindenhurst, NY. The radiology group and Steven Mendelsohn, MD, will pay $8,153,727 to resolve allegations that from Jan. 1, 2003, through Oct. 26, 2015, Zwanger submitted claims for services provided or supervised by physicians, or at a Zwanger location, that were not enrolled in Medicare and/or Medicaid and therefore ineligible for payment.
“Zwanger falsely claimed that Dr. Mendelsohn, who was a Medicare- and Medicaid-enrolled provider, had, in fact, performed the procedures,” the prosecutors said in a statement announcing the settlement. (The statement can be found at: http://on.ny.gov/2gIrFXB.)
Prosecutors also alleged that the group submitted false claims to Medicare and Medicaid for procedures, including the automatic performance of certain types of X-rays and the automatic performance of ultrasounds in female patients, even though the procedures were not ordered by a treating physician.
The government investigated after whistleblowers filed a qui tam lawsuit under provisions of the state and federal False Claims Acts. The whistleblowers will receive $221,802 from New York’s $1.2 million share of the total settlement.