Maryland hospital, imaging group pay $2M to settle false claims allegations

Lanham, Md.-based Luminis Health Doctors Community Medical Center and Diagnostic Imaging Associates have agreed to pay more than $2 million to resolve allegations that they violated the False Claims Act. 

According to prosecutors, Luminis and Diagnostic Imaging entered into an arrangement in which the imaging group billed Medicare and Medicaid under its assigned number for professional services provided by Diagnostic Imaging and for technical services provided by Luminis' outpatient cancer screening facility. 

Diagnostic Imaging allegedly then paid the cancer facility a piece of the reimbursed global fee for the technical services provided by the facility. A global fee reflects payment for both the technical and professional components of a medical service billed together. However, the cancer facility was not enrolled in Medicare and Medicaid during that time and did not have an eligible billing number for reimbursement. 

Between March 2010 and October 2020, Diagnostic Imaging submitted claims to Medicare and Medicaid using its supplier number to bill for both the professional and technical components of the services rendered in the cancer facility even though Luminis performed the technical component of the cancer facility's services, according to the Justice Department. Prosecutors said Luminis and Diagnostic Imaging knew that the cancer facility did not have a proper billing number to be eligible for reimbursement.

The settlement is not an admission of guilt by Luminis or Diagnostic Imaging.

A spokesperson for Luminis shared the following statement with Becker's

"Shortly after Luminis Health acquired Doctors Community Hospital in the summer of 2019, our compliance department discovered the Breast Center was using the wrong provider number for billing certain services. Luminis Health immediately investigated the matter, took action to fix the problem and self-reported it through the United States Department of Health and Human Services Provider Self-Disclosure Protocol. Luminis Health has a robust compliance program that seeks to prevent, identify and mitigate potential activity that does not comply with health regulations. This self-disclosure demonstrates our commitment and effectiveness of our proactive compliance program."

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