Diagnostic Systems Inc., Southeast Georgia Open MRI, Open MRI at Fountain Lake, and Open MRI of Douglas have agreed to pay the United States $1,273,126 to settle allegations that those facilities submitted false claims to Medicare, Georgia Medicaid, TRICARE, and the Federal Employees Health Benefit Program for certain MRI procedures that were not supervised as required by a physician.
A MRI is a common medical imaging technique. With certain MRI procedures, a contrast agent may first be injected into a patient to produce a clearer diagnostic picture. The use of contrast, however, could pose significant health risks to a patient. For this reason, under Medicare regulations, MRI procedures with contrast require a physician to be present or immediately available to handle any emergencies that may arise. MRI facilities generally receive a higher rate of reimbursement for procedures that use a contrast agent (as opposed to MRIs without contrast).
The government alleged that from about January 2007 to October 2011, Open MRI facilities in Brunswick, Douglas and Savannah performed hundreds of MRI procedures using contrast but without any physician supervision. In most instances, only clerical staff and a technician were on site during the procedures. Open MRI then billed various federal health care programs for those unsupervised procedures.
"Health care providers cannot put profits above patient safety," United States Attorney Edward J. Tarver said in a news release. "Medicare, Medicaid and other federal health care programs operate on the honesty of its providers, and this office will actively pursue those who misuse the programs for financial gain."
In connection with the settlement, Open MRI also entered into a five-year corporate integrity agreement with the government that contains provisions intended to ensure the company's compliance with Medicare regulations in the future.