United States of America et al v. Preferred Imaging Centers, L.L.C.

Dallas, TX - Prefered Imaging, LLC to Pay $3,510,000 to Resolve False Claims Act Allegations



Preferred Imaging, LLC, (Preferred Imaging), a provider of diagnostic imaging services, has agreed to pay $3,510,000 to resolve allegations that it improperly billed Medicare and Medicaid for services performed without proper medical supervision in violation of the False Claims Act and the Texas Medicaid Fraud Prevention Act. Preferred Imaging cooperated with the investigation and, by settling, did not admit any wrongdoing or liability.



Preferred Imaging operates independent diagnostic facilities (IDTFs) in Texas, Illinois, and Kansas. Certain procedures performed by IDTFs, such as procedures involving the administration of contrast dye, must be supervised by an on-site physician. The settlement resolves allegations that Preferred Imaging submitted claims to Medicare, Medicaid, and TRICARE for procedures that were performed between January 2009 and February 2015 without a supervising physician on-site.



“The requirement that certain services are supervised by a physician is in place to protect Medicare and Medicaid patients,” said U.S. Attorney Parker. “This settlement clearly reflects our commitment to hold facilities responsible for failing to ensure that those requirements are satisfied.”



The settlement resolves allegations filed by relator Tracy Sifuentes, a former employee of Preferred Imaging, under the qui tam or whistleblower provisions of the FCA and TMFPA, which authorize private parties to sue for fraud on behalf of the United States and State of Texas and share in the recovery. The relator will receive $596,700.



The investigation was conducted by Health and Human Services Office of Inspector General, Defense Criminal Investigative Services, and the Texas Attorney General's Civil Medicaid Fraud Division.





Title 31 U.S.C. §3729. False claims



(a) Liability for Certain Acts.—



(1) In general.—Subject to paragraph (2), any person who—



(A) knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval;



(B) knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim;



(C) conspires to commit a violation of subparagraph (A), (B), (D), (E), (F), or (G);



(D) has possession, custody, or control of property or money used, or to be used, by the Government and knowingly delivers, or causes to be delivered, less than all of that money or property;



(E) is authorized to make or deliver a document certifying receipt of property used, or to be used, by the Government and, intending to defraud the Government, makes or delivers the receipt without completely knowing that the information on the receipt is true;



(F) knowingly buys, or receives as a pledge of an obligation or debt, public property from an officer or employee of the Government, or a member of the Armed Forces, who lawfully may not sell or pledge property; or



(G) knowingly makes, uses, or causes to be made or used, a false record or statement material to an obligation to pay or transmit money or property to the Government, or knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay or transmit money or property to the Government,



is liable to the United States Government for a civil penalty of not less than $5,000 and not more than $10,000, as adjusted by the Federal Civil Penalties Inflation Adjustment Act of 1990 (28 U.S.C. 2461 note; Public Law 104–410 1), plus 3 times the amount of damages which the Government sustains because of the act of that person.



(2) Reduced damages.—If the court finds that—



(A) the person committing the violation of this subsection furnished officials of the United States responsible for investigating false claims violations with all information known to such person about the violation within 30 days after the date on which the defendant first obtained the information;



(B) such person fully cooperated with any Government investigation of such violation; and



(C) at the time such person furnished the United States with the information about the violation, no criminal prosecution, civil action, or administrative action had commenced under this title with respect to such violation, and the person did not have actual knowledge of the existence of an investigation into such violation,



the court may assess not less than 2 times the amount of damages which the Government sustains because of the act of that person.



(3) Costs of civil actions.—A person violating this subsection shall also be liable to the United States Government for the costs of a civil action brought to recover any such penalty or damages.



(b) Definitions.—For purposes of this section—



(1) the terms “knowing” and “knowingly”—



(A) mean that a person, with respect to information—



(i) has actual knowledge of the information;



(ii) acts in deliberate ignorance of the truth or falsity of the information; or



(iii) acts in reckless disregard of the truth or falsity of the information; and



(B) require no proof of specific intent to defraud;



(2) the term “claim”—



(A) means any request or demand, whether under a contract or otherwise, for money or property and whether or not the United States has title to the money or property, that—



(i) is presented to an officer, employee, or agent of the United States; or



(ii) is made to a contractor, grantee, or other recipient, if the money or property is to be spent or used on the Government's behalf or to advance a Government program or interest, and if the United States Government—



(I) provides or has provided any portion of the money or property requested or demanded; or



(II) will reimburse such contractor, grantee, or other recipient for any portion of the money or property which is requested or demanded; and



(B) does not include requests or demands for money or property that the Government has paid to an individual as compensation for Federal employment or as an income subsidy with no restrictions on that individual's use of the money or property;



(3) the term “obligation” means an established duty, whether or not fixed, arising from an express or implied contractual, grantor-grantee, or licensor-licensee relationship, from a fee-based or similar relationship, from statute or regulation, or from the retention of any overpayment; and



(4) the term “material” means having a natural tendency to influence, or be capable of influencing, the payment or receipt of money or property.



(c) Exemption From Disclosure.—Any information furnished pursuant to subsection (a)(2) shall be exempt from disclosure under section 552 of title 5.



(d) Exclusion.—This section does not apply to claims, records, or statements made under the Internal Revenue Code of 1986.

Settled for $3,510,000.