A False Claims Act action out of the District of Columbia alleges that at least over 500 doctors nationwide overbilled Medicare for administering doses of radiopharmaceuticals. Radiopharmaceuticals—radioactive compounds used in imaging procedures such as myocardial perfusion imaging—play a critical role in identifying coronary artery disease and other cardiac conditions. However, recent investigations scrutinize the billing practices associated with radiopharmaceuticals.
The False Claims Act imposes liability on individuals and entities that knowingly submit false claims to federal healthcare programs, or cause others to do so. Importantly, liability can be attached even when the false claim results from reckless disregard or deliberate ignorance, not just intentional fraud.
At the end of 2024, sixteen cardiology practices agreed to pay a total of $17.7 million to resolve False Claims Act allegations related to alleged inflated Medicare reimbursements.[1] “The government alleged that the settling cardiology practices regularly reported inflated acquisition costs to Medicare for these drugs.”[2] Now, the matter continues through a Second Amended Complaint where Relators are continuing to allege that the individual doctors violated the False Claims Act by allegedly overbilling federal payors.
As the False Claims Act matter continues, despite a significant settlement, practices using radiopharmaceuticals or those part of the radiopharmaceutical supply chain, are encouraged to invest in robust quality assurance systems and to stay informed on evolving regulatory guidance. Healthcare providers using nuclear cardiology testing are advised to conduct internal audits and consult legal counsel to ensure all practices align with federal and state laws.
How Frier Levitt Can Help
Our team regularly defends healthcare providers facing False Claims Act investigations or audits related to radiopharmaceutical billing practices. If you or your practice received notice that you are the subject of a government investigation, an audit from the Centers for Medicare and Medicaid Services (“CMS”), or if you are named as a Defendant in a qui tam litigation, please reach out to our knowledgeable counsel at Frier Levitt.
[1] https://www.justice.gov/archives/opa/pr/sixteen-cardiology-practices-pay-total-177m-resolve-false-claims-act-allegations-concerning
[2] See, id.
Senior Associate
