By Nina Youngstrom
Managing Editor of Report on Medicare Compliance
An Excerpt Taken from an Issue of Report on Medicare Compliance
An Oklahoma hospital and a former top executive have agreed to settle false claims allegations that it billed Medicare for radiology procedures without the requisite physician supervision. Six physicians also were held accountable for the false claims allegedly submitted by Norman Regional Health System, and they had to pony up part of the $1.6 million false claims settlement, the U.S. Attorney’s Office for the Western District of Oklahoma said April 11.
The false claims complaint centered on radiology services that require personal supervision by radiologists, which means a radiologist must be in the room when the services are performed. The hospital allegedly billed Medicare for procedures performed by radiology practitioner assistants (RPAs) without personal supervision. The scheme allegedly got a hand from Greg Terrell, who was chief operating officer and senior vice president of Norman Regional Health System. “Defendant Terrell abdicated his responsibility and authority to prevent or correct the false billings,
and he failed to do so and as a result, [the health system] obtained substantial financial benefit,” according to the complaint.
The inclusion of Terrell and the six physicians in the settlement are an example of the Yates memo in action, says former federal prosecutor Melissa Jampol, who is with Epstein Becker in New York City. The Yates memo, formally called the Individual Accountability Policy, is DOJ’s blueprint for nailing culpable individuals when settling corporate fraud cases (RMC 9/14/15, p. 1). “This shows the strong influence of the Yates memo,” she says. Some people think the Yates memo is “confined to the criminal realm, but it also applies to the civil realm. The fact that Terrell held a senior leadership position and was directly responsible for billing put him squarely within the Yates memo’s concerns and the allegations were pointed directly at him
at times,” Jampol says. In another civil case, the former CEO of Tuomey Healthcare System agreed to pay $1 million over the alleged part he played in the sweetheart deals that turned the South Carolina health system inside out (RMC 10/3/16, p. 1).
Physician Was Also the Whistleblower
As is typical of many false claims cases, the lawsuit against Norman Regional Health System began with a whistleblower, radiologist Lance Garber, who was employed by the hospital from 2008 to around March 2012. According to the complaint, RPAs performed diagnostic and nondiagnostic procedures at the hospital. “When an RPA performs a procedure that requires personal supervision, the radiologist must be present in the room, even if the RPA has been trained to perform the procedure and it is within his or her stated scope of practice,” the complaint states. Without the physician’s personal supervision, the hospital and the radiologist are not allowed to bill Medicare for the services performed by the RPAs. Six physicians employed by the hospital allegedly submitted Medicare claims for radiology procedures performed by RPAs without their personal supervision, and they were also named in the complaint.
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