Ambulatory cardiac monitoring company CardioNet has agreed to pay $6.4 million to resolve legal allegations of over billing Medicare and other federal health programs for their Mobile Cardiac Outpatient Telemetry (MCOT) services. CardioNet, a wholly owned subsidiary of Biotelemetry Inc. is headquartered in Malvern, Pennsylvania, , that its subsidiary, CardioNet,
The government’s Justice Department claims that under the False Claims Act (FCA) that CardioNet was billing Medicare and other insurances for their MCOT service when those services were not medically necessary. The government takes the position that MCOT services are not eligible for Medicare reimbursement for patients with low to moderate heart palpitations since other, less expensive forms of monitoring can effectively acquire the needed information about these patients. CardioNet is accused of submitted claims to Medicare for patients containing the more expensive Mobile Cardiac Telemetry billing code along with inaccurate diagnosis codes that misrepresent the true condition of the patient.
This settlement is a good example of how the government plans to crack down on health care fraud. This action taken against CardioNet was performed through the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative that was announced in May 2009 by the Attorney General and the Secretary of Health and Human Services. The initiative is focused to prevent Medicare and Medicaid fraud through the False Claims Act. Through this new initiative, the government has recovered a total of more than $23.8 billion since 2009.