Rose Radiology Agrees to Plead No Contest to Allegations of Medicare Fraud and Pay Nearly $9 million to settle Alleged False Claims Act Violations
The government’s concerted efforts against companies that are alleged to have defrauded Medicare and Medicaid continues even against companies that steadfastly deny their guilt. As an example of this, last week the government alleged that Rose Radiology had billed for radiological procedures based on referrals that Medicare does not cover. Additionally, the government also alleged that Rose billed for and performed procedures that weren’t ordered by healthcare providers, billed Medicare for services done at non-Medicare approved facilities and that it violated the Anti-Kickback Statue (42 USC § 1320a-7b(b)) by giving referrers kickbacks such as lunches, gift cards and tickets to events.
For their part, officials at Rose have denied all allegations of wrong doing calling the charges “baseless and without merit.” Officials at the company went on to contend that the decision to settle was purely based on practical considerations such as the government’s “limitless” resources it uses in prosecuting such cases. “Faced with a lawsuit that could potentially destroy my practice, I elected to settle so needed radiology services could still be provided to our community. It’s so unfortunate that health care professionals are being targeted, especially if they work hard and have a successful practice,” says the firm’s founder, Dr. Manual Rose. Two Rose-employed physicians filed the suits that lead to the $8.71 million settlement. Their share of the settlement – under the False Claims Act whistleblower portion of the law – is estimated to be $1.7 million. (The law allocates whistleblower rewards that generally range from between 15% – 30% of any settlement.)
The government maintains the validity of the charges against Rose. “Not only do the kinds of frauds that were alleged in this case rob Medicare of needed funds, they threatened the health of elderly and disabled Americans,” said Shimon Richmond, special agent in charge for the Health and Human Services Office of the Inspector General. The investigation of Rose comes on the heels of the government’s crackdown on alleged Medicare fraud cases which began as an initiative back in 2009 under the current Obama administration.