A Southland doctor and medical imaging company have agreed to settle a whistleblower’s False Claims Act lawsuit alleging improper billing for radiology services under federal health care programs, the U.S. Department of Justice announced Wednesday.
The settlement resolves allegations that Dr. William M. Kelly’s medical practice and Omega Imaging Inc. submitted claims for CT scans and MRIs involving contrast injections that were not properly supervised by a physician, according to the DOJ.
The lawsuit was initially filed in 2013 in Los Angeles federal court.
“Patients rightly expect that medical providers follow the proper procedures and protocol when administering complex treatments to ensure patient safety,” said Timothy B. DeFrancesca, special agent in charge for the Office of Inspector General of the U.S. Department of Health and Human Services.
Applicable program rules require a physician to be present in the office suite when a patient undergoes an examination that involves the administration of intravenous contrast material. The defendants allegedly performed and billed for the procedures when no supervising physician was present in the office suite.
The settlement also resolves allegations that a certain number of the defendants’ facilities lacked accreditation.
Contemporaneous with the settlement, Kelly/Omega entered into a three-year agreement the U.S. Department of Health and Human Services Office of Inspector General requiring, among other things, the implementation of a risk assessment and internal review process designed to identify and address evolving compliance risks. The agreement requires training, auditing, and monitoring designed to address the conduct alleged in the case.
The settlement, which was based on the defendants’ ability to pay, resolves allegations originally brought in a lawsuit filed under the qui tam, or whistleblower, provisions of the FCA by Syd Ackerman, who was formerly employed by the defendants.
The FCA permits private parties to sue on behalf of the government for false claims and to receive a share of any recovery. The FCA permits the United States to intervene in such a lawsuit, as it did in part here. Ackerman will receive about $925,000 of the settlement proceeds, according to the DOJ.
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