December 23, 2022

False Claims Act Liability: Pennsylvania Health Companies to Pay More Than $44 Million for Medicare Fraud

Two Pennsylvania health companies, BioTelemetry, and its subsidiary, CardioNet LLC, have agreed to pay over $44 million to settle allegations that they violated the False Claims Act by knowingly submitting claims to Medicare, TRICARE, the Veterans Health Administration, and the Federal Health Benefits Program for heart monitoring tests. The United States government claimed that CardioNet improperly billed Medicare and other federal health care programs for certain cardiac monitoring services such as event monitoring, and mobile cardiovascular telemetry tests that were performed outside the United States in violation of a federal law that prohibits payments for services performed outside the U.S. In addition, in several cases, many of the technicians were not qualified to perform these cardiac tests. The United States government specifically asserted that in 2013, CardioNet contracted with a company based in India for diagnostic and analysis services for cardiac monitoring data. BioTelemetry designed a system that was supposed to direct electrocardiogram data for federal healthcare beneficiaries to a U.S. independent diagnostic testing facility for review and analysis. The government, however, maintained that BioTelemetry diverted certain federal beneficiary data to India when the domestic workflow was backlogged.

The government alleged that in 2014, over 78% of the data reviewed in connection with event monitoring tests for Medicare patients were reviewed by technicians in India. What’s more, in 2015, that number allegedly spiked to 88%. While BioTelemetry attempted to implement technological controls in order to prevent personnel in India from having access to the domestic workflow, the controls were unable to prevent such and the technicians in India were thus able to review and analyze a significant amount of cardiac data for federal healthcare program beneficiaries.

Of more than the 450 technicians located in India who reviewed Medicare patients’ data in connection with MCT services that CardioNet billed to Medicare from 2013 to 2018, the government contended that less than 3% of their technicians were certified by Cardiovascular Credentialing International (CSI). CSI is the only recognized credentialing body for such cardiovascular technicians.

The civil settlement brought under the qui tam or whistleblower provisions of the False Claims Act for over $44 million also included a five-year Corporate Integrity Agreement entered into with BioTelemetry and the U.S. Department of Health and Human Services Office of the Inspector General. This agreement requires, among other things, that certain risk assessment and review processes intended to identify and address compliance risks be implemented within BioTelemetry’s systems. Further, the agreement also requires that an independent review organization assess the medical necessity and appropriateness of claims billed to Medicare on an annual basis.

This case demonstrates the United States government’s tireless efforts, with the help of whistleblowers, to combat healthcare fraud using the False Claims Act, one of the most powerful tools at the government’s disposal.



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