U.S. ex rel. Ortolano v. Amin Radiology (Summary)

QUI TAM

U.S. ex rel. Ortolano v. Amin Radiology, No. 5:10-cv-583-Oc-10TBS (M.D. Fla. Oct. 3, 2013)

The United States District Court for the Middle District of Florida granted in part and denied in part a private radiology company’s motion to dismiss a qui tam action brought by a former employee.

The former employee alleged that the radiology company failed to properly register a radiology center as an independent diagnostic testing facility, and instead, it registered the center as a physician practice group.  The district court, in granting this part of the motion, found that there is no requirement in Medicare that the provider enroll as one type of provider versus another type of provider and such a misclassification does not provide for any penalties.

The former employee also alleged that the radiology center submitted claims for MRI and PET procedures without the proper level of supervision, and that these procedures were performed by unlicensed and uncertified technicians.  The court granted this part of the motion, because the former employee’s specific identification of numerous procedures submitted for reimbursement that constituted false claims, coupled with his position as an insider working during the relevant time period with the ability to personally observe the events, was more than enough to satisfy the reliability of a claim for relief.  Also, the former employee not only discussed an MRI and PET scan submitted in violation of Medicare regulations, but also attached a spreadsheet listing over 300 claims submitted for reimbursement detailing the amount of charges, dates of procedures, and the amount reimbursed, all of which were enough to plead a False Claims Act violation.