Photo Credit: Okguy (Own work), via Wikimedia Commons
Norman Regional Hospital's parent system Norman Regional Health System, several physicians, and a former administrator have agreed to pay $1.6 million to settle allegations that the hospital submitted fraudulent claims to Medicare for radiology services, the Department of Justice announced Tuesday.
The hospital, located in Norman, Oklahoma, provides radiological services and at one time employed radiological practitioner assistants in its radiology department. Certain radiological diagnostic services can not be billed to Medicare unless the RPA was properly supervised by a physician, meaning a physician must be in the room. If they are not, the service can't be billed to Medicare, the DOJ said.
According to the DOJ, from January 1, 2008, through September 30, 2016, Norman Regional and the defendants submitted, or caused to be submitted, false claims to Medicare for radiological services performed by RPAs that were not properly supervised by a physician.
The allegations were raised in a whistleblower, or qui tam, lawsuit filed in Federal District Court in Oklahoma City by Lance Garber, a former physician at the hospital. The DOJ said once Norman Regional was notified of the allegations, they cooperated with the investigation, though they did not admit liability.
"Norman Regional Health System has a robust compliance program that focuses on billing accuracy and compliance with all federal health benefit programs," said Chief Executive Officer Richie Splitt. "We are entering into this settlement agreement to resolve the allegations so that our employees, physicians, and administration can focus on our mission to serve our community as the leader in health and wellness care."
The DOJ did not disclose any monetary settlement Garber might receive as his share of the recovery, which is allowed in whistleblower lawsuits.