Ambulatory Care and Diagnostic Facilities

Ambulatory care and diagnostic facilities, including surgicenters and diagnostic imaging centers, have been common targets for False Claims Act suits, including for knowingly:

  • Billing for services that were not medically necessary
  • Billing for services not actually provided, or not provided as claimed
  • Offering, paying or receiving remuneration to influence the referral of patients (“kickbacks”)
  • Using billing codes that reflect a more severe condition than actually existed or more expensive care than was actually provided (“upcoding”)
  • Billing for services performed by an improperly supervised or unqualified employee
  • Billing for “worthless” services

Case Examples

A number of successful cases have been brought against ambulatory care and diagnostic facilities under the False Claims Act. By way of example:

In 2014, Diagnostic Imaging Group agreed to pay $15.5 million to settle whistleblower claims that the company violated the federal and state false claims statues by billing federal and state health programs for tests that were not performed or not medically necessary and by paying kickbacks to physicians for referring patients for diagnostic tests. The three whistleblowers in this case were two radiologists and a medical supply company representative, who received $2.8 million as their share of the settlement. Read more

In 2005, Resurgens Surgery Center, an outpatient surgical clinic, in Atlanta agreed to pay almost $3.8 million to resolve claims that it violated the False Claims Act by improperly billing Medicare and Medicaid. The whistleblower in this case was a former medical-practice administrator.

In 2000, Anwar Eye Center, an ambulatory surgical center specializing in cataract removal surgery and lens implants, agreed to pay $240,000 to settle claims that the center submitted false claims to Medicare, Medicaid and the Department of Defense’s TRICARE Program for procedures performed without a certified anesthetist. The whistleblower in this case was a certified nurse anesthetist. She received $43,845 as her share of the settlement. Read more

If you have knowledge and solid evidence of fraud or false claims by an ambulatory care or diagnostic facility, or another health care provider, please contact our whistleblower lawyers. Consultations are free and confidential.