A Medicare-established schedule determines when dialysis patients at high risk of contracting hepatitis B should be tested and reimburses dialysis clinics for the tests. But dialysis clinic operator Fresnius also gave those tests to patients who were immune to the infection and therefore didn’t need them, the Justice Department alleges.
Fresnius, based in Germany, conducted the tests on immune patients from Feb. 10, 2003 to Dec. 31, 2010, according to the Justice Department.
“In many cases, Fresenius performed and billed Medicare for these tests for immune patients against their treating physicians’ orders and without any accompanying documentation of medical necessity,” the department added. “These tests were not eligible for Medicare reimbursement under Medicare’s testing frequency schedule, and the government alleged that Fresenius’s bills for these tests were false.”
The $5.2 million settlement resolves allegations originally brought through a whistleblower lawsuit filed under the False Claims Act. The whistleblower, a former Fresenius employee, will receive 27.5 percent of the recovery.
More articles on legal and regulatory issues:
Pennsylvania surgeon settles false billing allegations for $4.25M
New York BCBS plans allegedly overpaid hospitals by $85M
Physicians, medical group CEO pay $6.7M to settle billing fraud case in California
Becker’s 3rd Annual Fall Chief Pharmacy Officer Summit is the top tier event that the people leading the future of pharmacy convene. This 3-day event is built specifically for Chief Pharmacy Officers and senior pharmacy leaders. The sessions examine the workforce, financial and clinical priorities shaping pharmacy today. Becker’s is where candid discussions flourish and new ideas thrive. Becker's 3rd Annual Fall Chief Pharmacy Officer Summit
