Scranton Heart Institute Reaches $48,709 Settlement Over Medicare Billing Allegations

The United States Attorney’s Office for the Middle District of Pennsylvania has announced that Scranton Heart Institute (SHI) has agreed to a settlement of $48,709.20 to resolve allegations that it submitted false claims for payment to Medicare. These allegations center on the submission of claims for CPT codes related to PET scan services that allegedly violated applicable Medicare rules and regulations. The claims in question span from December 10, 2020, to May 31, 2023.

According to the U.S. Attorney’s Office, the settlement stems from allegations that SHI knowingly and willfully received compensation from a mobile PET scan company. This compensation was allegedly offered or paid to induce SHI to refer its Medicare patients to the mobile company for PET scans. The remuneration reportedly took the form of significant hourly payments, described as compensation for professional supervision of the mobile imaging services, and the allowance for SHI to bill Medicare for and retain the professional component reimbursement for these mobile imaging services. The United States contends that these arrangements led to SHI submitting false claims to Medicare for imaging services, identified by specific CPT codes, which were a result of violations of the Anti-Kickback Statute. Furthermore, the U.S. Attorney’s Office asserts that the compensation received by SHI from the mobile PET scan company created a financial relationship between SHI’s physician and the mobile PET scan company that did not meet any exceptions to the physician self-referral law.

The U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) has stated that kickback schemes can compromise medical decision-making, potentially impacting patient care and increasing program costs. The HHS-OIG remains committed to collaborating with the U.S. Attorney’s Office and other partners to investigate alleged violations of the Anti-Kickback Statute within the Medicare program. This specific matter was managed by Assistant U.S. Attorney Tamara Haken and the Affirmative Civil Enforcement Unit of the U.S. Attorney’s Office for the Middle District of Pennsylvania, with support from the HHS-OIG. It is important to note that the claims resolved by this settlement are allegations, and no determination of liability has been made.

Article by Mel Anara, based upon information from the U.S. Attorney’s Office, Middle District of Pennsylvania

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