On March 19, 2015, the Department of Justice announced that BioTelemetry, Inc. agreed to pay $6.4 million to resolve allegations that its subsidiary, CardioNet, violated the False Claims Act by overbilling Medicare and other federal healthcare programs for services that were not reasonable or medically necessary.
CardioNet provides Mobile Cardiac Outpatient Telemetry services (MCOT). An MCOT monitor provides real-time, outpatient cardiac monitoring by continuously recording the patient’s heart, including any irregular rhythms or other cardiac events, and transmitting that data to CardioNet’s diagnostic center over a cellular network.
The government alleges that CardioNet submitted claims to Medicare for patients who had only mild or moderate heart palpitations using the billing code for the more expensive MCOT services with an inaccurate diagnostic code, when in fact, a less expensive heart monitor would have sufficed to monitor the patient. “Billing for a higher-level service that is not necessary to treat a patient’s condition to receive a higher reimbursement from federal health care programs will not be tolerated,” noted Acting Assistant Attorney General Benjamin C. Mizer. “Such conduct wastes critical federal health care program funds and drives up the costs of health care for all of us.”
The investigation of BioTelemetry, Inc., and CardioNet, was handled by the Department of Justice’s Commercial Litigation Branch, in conjunction with the U.S. Attorney’s Office for the Western District of Washington and HHS-OIG. The settlement is part of the government’s Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was initially started in 2009.
Since 2009, the Department of Justice has recovered a total of more than $23.8 billion through False Claims Act cases, with more than $15.2 billion of that amount recovered in cases involving fraud against health care programs. According to Annette L. Hayes, the Acting U.S. Attorney for the Western District of Washington, “[t]oday’s settlement is another example of how we will act to stop abusive billing practices and hold companies accountable for conduct that raises everyone’s healthcare costs. This settlement should send a message to all providers: do not misuse federal billing systems to improperly gouge the healthcare system upon which many Americans rely.”