On December 22, 2009, the United States Attorney for the District of Connecticut announced that Dr. Barbara Kage and her medical practice, Rheumatology & Allergy Institute of Connecticut LLC (RAI) had agreed to pay $222,855 to resolve allegations of Medicare billing improprieties, including billing for facet joint blocks/injections (for back pain) not performed using fluoroscopic guidance, for several different physical therapy procedures that should not have been billed for the same patient at the same time, and for more expensive office consultation visits, instead of less expensive new patient visits. The case was brought as a whistleblower action. The relator (whistleblower), Dr. Mark Ruderman, is a retired physician who had treated some of Kage and RAI’s former patients. Dr. Ruderman’s share of the settlement is $33,428. http://www.justice.gov/usao/ct/Press2009/20091222.html
This case demonstrates the need for health care providers to regularly audit their Medicare billings. Had Dr. Kage and RAI done so, they might have discovered these billing improprieties and taken action to resolve the billing issues themselves, thereby avoiding the expense and hassle of defending themselves in a whistleblower lawsuit. Health care providers that ignore potential violations of law should be aware that potential whistleblowers are everywhere, both inside and outside their organizations.