The settlement resolves claims that Radiology Associates, an independent Corpus Christi, Texas, radiology group, along with Children’s Physician Services of South Texas (CPSST), billed government payors twice for the professional reading and interpretation of thousands of pediatric genetic ultrasounds over a five-year period.
The double billing -- a violation of the False Claims Act and the Texas Medicaid Fraud Prevention Act -- took place between 2002 and 2007 and was brought to light in February of 2008 when Diana Kulwicki, a former revenue manager and coding compliance officer with Radiology Associates, joined with the government to file a qui tam or whistleblower lawsuit against Radiology Associates.
According to the settlement, Kulwicki was first employed by Radiology Associates in 1997. Part of her duties involved auditing the group’s billing and that is how she discovered that CPSST was billing for the professional component of the pediatric genetic ultrasounds even though the agreement between it and Radiology Associates was that CPSST would bill only for the technical component and Radiology Associates would bill only for the professional component.
According to the press release from the U.S. Attorney for the Southern District of Texas announcing the settlement, Radiology Associates informed CPSST about the double billing for the professional component, but CPSST said it was just a few accidental and isolated occasions and that Radiology Associates should continue to bill for the professional component.
Radiology Associates accepted CPSST’s explanation and continued as before, even as additional evidence of double billing came to light.
Perhaps recognizing that Radiology Associates was following the agreed upon billing practice and CPSST was not, the government will collect the lion’s share of the settlement for the double billing from CPSST. In total, CPSST will pay $1.5 million to settle the claims, nearly twice what Radiology Associates will pay to the government.
Under the False Claims Act, Kulwicki will be entitled to between 15 to 25 percent of the total settlement, which could add up to as much as $575,000.
The investigation was conducted by the United States Department of Health and Human Services - Office of Inspector General and the Texas Attorney General's Medicaid Fraud Control Unit and Civil Medicaid Fraud Division. Assistant United States Attorney Jose Vela Jr., Assistant Texas Attorney General Christen Nedwick and MFCU Investigative Auditor Clint Lawhon led the investigation.